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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> 7' N tJ <br /> Applicant Complete All Sections Below This Line c " <br /> . „ : <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> C7 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> _1i!s. f •: . • := , - . $150 Addition/Alteration to Accessory Structure $150 �� <br /> F <br /> J 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 °< , �% <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cz. <br /> .)*NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <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 /> Property Owner's Name: t - -e-1--- f'\ . K.�Ic� z <br /> o <br /> Property Owner's Mailing Address: 670 'i=2, `E-r i Zzh1 -Z-Cs.G-� o <br /> City State Zip b <br /> Property Site Address: 1441-C. Gt..s GL 'e A' n <br /> E <br /> Contact's Telephone Number: (745)(5C':::(e, -� o g <br /> Contact's Email: -J JGpSkcc&- -ELLi_l L,C0741 <br /> �%� a.d <br /> Legal Description of Property: t0 V .SGU S E )( 51" ► V j L 09,c . CD <br /> N -o <br /> Section#: P.3 Town#: � j N Range#: /4:, W Town of: Mese 14c974 c <br /> ' °c <br /> S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 0 <br /> Tax ID#(1-5 digit number; found on tax statement): 2--mss/ . <br /> Proposed Use of Structure/A dition: d"c..J�'c. d'"C 6'`'N� `n ti <br /> Anticipated Start Date: -�/_ °y <br /> p 2 oat��o2� \ (Home/Cabin;Commercial Bus ness;Bedroom;Deck;etc.) c�.+� x <br /> Building Contractor: '�/ �d 666 a v 5 <br /> Yom\ Sewer Installer: ` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to .4 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouse .** rte( f i h { P' <br /> @Cairrizr ne 5 bel �n-4�,n du <br /> . J0 We be i{ ed on <br /> vi*r, 65P 1 e <br /> V,lOt • gyp -. <br /> 0/Meek all Sekba -s y Fee Rec: 5-,(j_ 141) <br /> ,1 41 <br /> N Check#: <br /> o _ <br /> II13/a-( m / It 1 <br /> Check Date of staff site visit: Initials of 'te visit staff:1 z <br /> /� - <br /> 7// / / <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: < <br /> ffi <br /> UPON APPROVAL: APPLICAN,. -'MUST POST COPY OFc <br /> �4 4� 1 c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o a N <br /> CD c ry <br /> Transcendent: - Page 1 of 4 n 4. G <br /> Laserfische: <br /> Burnett County, WI Land Use Application—Rev 12/2020 ,1 <br /> I _ a - sr 1 - ___ i -.d'1 41_ _/_ ..1...• 1J1,1 . 49._. 'a <br />