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LAND USE PERMIT APPLICATION— Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line ° � � <br /> Permit Types and Fees:(Please,check appropriate boxes) a tki <br /> b r� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ~ NW1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `15' <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 c <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 N. g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> ] <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< D �1 <br /> Filling/Grading $150 Boathouse $500 o ' • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 '" '� ' <br /> v <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. P> <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o 3 ' <br /> Property Owner's Name: .-LA die/ ACIA//S o f <br /> Property Owner's Mailing Address: /9 2 7 t✓e/tanir,1 51'N' 4,n,�,,r-pa/S /11/4/ 53 //' %' o <br /> Cify State Zip ba <br /> Property Site Address: 2770/ /1'rostr 2�,- /de65,4r Aux 5-4/s/93 c' <br /> Contact's Telephone Number: 6/2 . 9,S . 370/ o F <br /> a <br /> Contact's Email: 44.e/p ida//; st74 /, Co`i'f o <br /> °' <br /> CD <br /> Legal Description of Property: �prnr5� .r <br /> 71-ea o,aei9 .. <br /> '/ �� // N -e <br /> Section#: Zi Town#: 441 N Range#: /S W Town of: ._.)acksort 0. <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * °Q <br /> P S f f S Y P Q Y P P ryP g q <br /> Tax ID#(1-5 digit number;found on tax statement): S(J q <br /> Proposed Use of Structure/Addition: vine/Cot b,;, ( -QGA 7 - <br /> p w <br /> Anticipated Start Date: 4//512o,Z/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � � k <br /> Building Contractor: i T&per y ,tip , <br /> 1] �/ /� fX yq4eG Sewer Installer: <br /> -3 Crl <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed front them prior tor, <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z Jx <br /> home additions,and bunkhouses.** <br /> (U <br /> NO(441 ec5+ Se-GJr'O'I c de i s v��t4;r1 4.6e 7$4- <br /> SeA4j k wk:ci i Caee�rec) bi} k;Si{ PL W d'�r <br /> fikb <br /> v4:4-11 oia !• - c de.clA ftwt- ' t + <br /> 7 .c-t-::t': <br /> ' ✓� J Reb��q.��C9✓t x FeeeM i t C4-1 i vui <br /> _5224.w. <br /> Date of staff site visit: <br /> 5/fI; I Initials of site visit staff• q z <br /> / d �Q� <br /> 6/8/A1 r <br /> APPROVED BY LAND SERVICES OFFICIAL: -DATE: n a z u u` <br /> UPON APPROVAL: APPLICANT ' UST POST COPY OF v, <c. <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° -o N = <br /> Transcendent: - Page 1 of 4 " a- N <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 <br /> d <br /> 3 <br /> -o <br />