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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> , N <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) A ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 E 5-- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `., <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �'tf <br /> 1 <br /> � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° r <br /> Filling/Grading $150 Boathouse $500t+ - Ei <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 i <br /> r <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. cS <br /> D. <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. 0 <br /> _, r <br /> Property Owner's Name: ?C•TE..l1._ .a..£iLALC o <br /> Property Owner's Mailing Address: `t 3 3S- D is A qr N.):,/ Et-r-it%vE-A-- pnnt cs 33 <br /> City State Zip 'o <br /> Property Site Address: I)e8o1 v...S,-icArt.te C(ice 1,-Jt .) IoANSvrt„A W ,423 a g,• n <br /> 3 <br /> Contact's Telephone Number: ► cit, 109 0 o• r, <br /> ! a <br /> Contact's Email: pil,.ke t'\Q I i ve..•Ce m d <br /> Legal Description of Property: ! -M• .2e1 IG , AD r•11.1 u, 4-, V o 1 65444A-0 1,..A.A(/6 t3 Itf It lk <br /> � ( N 'L <br /> Section#: $'Z. Town#: 4401J N Range#: 15 W Town of: 5,, c- ,-) g. °O <br /> go <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPage.* <br /> P <br /> w <br /> Tax ID#(1-5 digit number;found on tax statement): "-I 70`I 6. <br /> Proposed Use of Structure/Addition: GA n-At c„e. lir c4 <br /> Anticipated Start Date: atxlUoY �ti:.a( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C ! <br /> Building Contractor: at,,corn Sewer Installer: I- <br /> -3 G <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 <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured Z C) <br /> home additions, and bunkhouses.** �.,5 7 <br /> 0meet ci LI 5e�-ba. , ,01 <br /> 0 Nc,4- 5( k,,4,04.4 <br /> cf-o <br /> Fee Rec: <br /> Check#: Lt l.S <br /> Date of staff site visit://1C) /j-I Initials of:'te visit sta `.--- a <br /> 1 11APPROVED BY LAND SERVICES OFFICIAL: 1 ! ✓� /r DATE:707 ! �r <br /> UPON APPROVAL: APPLICAN / ST POST COPY OF . �c. <br /> ei c r- \ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 y- Q, <br /> Do <br /> Transcendent: - Page 1 of 4 m° c <br /> Burnett County, WI Land Use Application-Rev 12/2020 li <br /> 4 <br /> Laserfische: - A a, <br /> a <br />