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LAND USE PERMIT APPLICATION - Burnett County, WI a [ <br /> b <br /> Applicant Complete All Sections Below This Line a N <br /> Permit Types and Fees:(Please,check appropriate boxes) �- ~ <br /> Dwelling/Principal Structure $300 )( Addition/Alteration to Dwelling/Principal Structure $200 e <br /> Commercial/Industrial Structure $300 X, Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C") v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 <br /> E. <br /> Six Month Camping Per Year)g Unit(One $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cil <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. d <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. lZ FP, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -C gb <br /> -' (.. <br /> Ka,Ice, 1601 neX- . <br /> Property Owner's Name: ] o. <br /> II. <br /> Property Owner's Mailing Address: 25545 firer) Ii'UOOG�S I r1 UU�.bsiC.V �'V 1 548,1 3 c �. <br /> City State Zip <br /> Property Site Address: SC\me m a 7OYe, = n <br /> Contact's Telephone Number: 1 15- 5(ili' 1 5 o y <br /> co <br /> a. <br /> Contact's Email: laNCe. rose 93 @ ma,1 IO>) o <br /> n �A nn q (A) nLegal Description of Property: L c4 Z CS i4 3�gB 4 iIz p 7 / E ,v ttl) I <br /> Section#: 2ei Town#: N <br /> 1 N Range#: I ' W Town of: f n o-n _ °G <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* °C <br /> ,f f SY P Y P P YPb p <br /> Tax ID#(1-5 digit number; found on tax statement): Iak <br /> 2 ' <br /> Proposed Use of Structure/Addition: HOYY)C `n <br /> Anticipated Start Date: JO I 5. 202.1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W o x <br /> o <br /> Building Contractor: e)rad Spot ff>Yrd Sewer Installer: ewex already e ,ding <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (� <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 to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions, and bunkhouses.** x <br /> 1 twelliA/i if -v ecceed X beds S ?er 5O 5� <br /> I l7UU <br /> Meet- all Se-1'1)44,5 <br /> Ivee�, 110C114 ;A oft 51+k 4� 1- 9111?-1 <br /> Fee Rec: )u,.D <br /> K Check#: C4}-5/-1- <br /> Date of staff site visit: 'il _ f j�// I Initials of site visit st,ff: �"l/ <br /> z <br /> /, <br /> APPROVED BY LAND SERVICES OFFICIAL: Aa,, � /�, ,l DATE: 015/1)1 < <br /> UPON APPROVAL: APPLICANT �r UST POST COPY OF s =rr c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zd ' g <br /> :c t7 o <br /> Transcendent: - Page 1 of 4 x $ N C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 711 R <br /> C "" <br /> v; ' <br /> ; t`l J <br />