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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> N N <br /> Applicant Complete All Sections Below This Line _ ' <br /> Permit Types and Fees:(Please,check appropriate boxes) a' <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,"� 0' <br /> ' <br /> ) Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Po <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n <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 /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. fw <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. --o <br /> 1.A) 1 I u 4 1 c j s,i L , ---c��1�P C 9 z �i <br /> Property Owner's Name: I rr� <br /> ,• <br /> l� Pci <br /> 0 ,, <br /> Property Owner's Mailing Address: '( lU S oir b e r' Kc t1�� er i -5- '413 °o <br /> City State Zip 0 <br /> Property Site Address: 5 u rY\ 0' <br /> Contact's Telephone Number: 1 I S _6 le la - x-10 X17 <br /> o I <br /> 1 <br /> Contact's Email: C' C�T—C-1`IQC 9 mot 1 ,aon1 471i::> o <br /> Legal Description of Property: E W -f,. <br /> ca <br /> N -o <br /> Section#: I I Town#: 3f N Range#: I NI W Town of: ] y 1,h ej 5 0 °q <br /> 5. <br /> o-0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> 4- <br /> Tax ID#(1-5 digit number; found on tax statement): 0 O 0 •� 2' <br /> Proposed Use of Structure/Alldition: l .,/ \ 13 x o� 0 `" <br /> Anticipated Start Date: 1�( ic ' (Home/Cahin;Commercial Business;Bedroom;Deck;etc.) K <br /> d d <br /> Building Contractor: S Q\-V-- Sewer Installer: 1\011`Q-- <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 from them prior to ('6 r � <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z --- <br /> V <br /> home additions bunkhouses.** ,x' <br /> 0 �//�.�h((,, ab/( <br /> 0 TV rxi--- Sol Ituou'll 61°4 44 <br /> x Fee Rec: t <br /> 0 <br /> Check#: 4 <br /> Date of staff site visit:11/5 49, 7� <br /> r <br /> Initials f site visi staff:4, <br /> • <br /> • <br /> if En <br /> rri —J-.-----3' <br /> APPROVED BY LAND SERVICES OFFICIAL: r DATE: < r <br /> UPON APPROVAL: APPLICAN ' ?7/Q'2 UST POST COPY OF <br /> CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y 0 N <br /> < Ag <br /> ' <br /> Transcendent: Page 1 of 4rn <br /> a.� erg c <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 ` g <br /> F <br /> L <br />