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A <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 8' <br /> Permit Types and Fees:(Please,check appropriate boxes) i .-,..- .ec.- ..&, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r. 04) <br /> Accessory Structure(Garage,Shed,etc.) $150_X Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 1 ° <br /> • Ctt -- <br /> `1 <br /> Filling/Grading $150 Boathouse $500 0 10 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 T <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> n Ilk <br /> Property Owner's Name: G/-e e' r + N 4t;n e y k7 ek. r- z <br /> Property Owner's Mailing Address: 1©7 G` i a 5t E .44,54 r n/1s in 4'J 55 6.35 0 0 <br /> city State Zip 0 <br /> Property Site Address: 4 I7OO Lar r Ake S;17 NS iv 0 Rri I ,s-f r itt).j- 5ia J 3 ... ,.. <br /> Contact's Telephone Number: 4.51 21,1 73e io y <br /> f _ CD <br /> Contact's Email: 66 • <br /> ff e 5 9.mx+ � , CD', 7 .0.o <br /> ,r 2 <br /> Legal Description of Property: ifsb/a /Ate Si& Le+ 7 }f o`7-oI't 2 3g,(5-o5.5t5•s�i5.' <br /> 0 1,ip act by ab <br /> Section#: Town#: N Range#: W Town of: t.o'f-')//..tie, oE. <br /> °*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> p <br /> a. <br /> Tax ID#(1-5 digit number; found on tax statement): /0'173 <br /> Proposed Use of Structure/Addition: fA R',(( I 1\16, CA <br /> Anticipated Start Date: lila y `Ai (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) £ X <br /> Building Contractor: $e L 42Sewer Installer: NA r. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COVINTENTS/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 from them prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** <br /> 0 meek all Se-�'bs (6 <br /> CP IU of ktelar hab;+m-F,on <br /> Fee Rec: 1 �(S' <br /> U Check#:lige) <br /> afa-14 ( ' I <br /> Date of staff site visit: Initials of site visit staff: AO, > <br /> 1 f • / —APPROVED BY LAND SERVICES OFFICIAL: f� %� - DATE: �j / c < r" �rr <br /> UPON APPROVAL: APPLICANT ' UST POST COPY OF z (� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o -- <br /> Transcendent: - Page 1 of 4 m 4 C <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 < 2 V <br /> T <br /> o `. <br /> 4 <br />