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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line =' G <br /> N1 <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F.Z .4 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..,� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 j F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 F <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ,- 1 <br /> Driveways/&Campground Structures ° <br /> y pg $125 WI State Statute 59.692(ly)Structures $350 �� <br /> 1 Filling/Grading $150 Boathouse $500 r- ,(` Q <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> rn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. E. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ap <br /> Property Owner's Name: 54-e\/o A k • More ° z <br /> Property Owner's Mailing Address: I Le 3a1SII CJ (/ Va 70 o ' W 'o 0 <br /> a. <br /> Saki <br /> ��, J� j�, I City State Zip <br /> Property Site Address: j tP 361 S fr I I I-h 0 r p sI W l " <br /> cn <br /> Contact's Telephone Number: (p0 I t1% I 5911 o y <br /> co <br /> a. <br /> Contact's Email: <br /> r CD <br /> d <br /> Legal Description of Property: Doi( 1;01/1144. (sir V 3 I b 7 <br /> Section#: 2. Town#: 3 S Range#: 1 9 W Town of: e v. <br /> 0 oc <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> zz <br /> Tax ID#(1-5 digit number; found on tax statement): 73 S II ' <br /> Proposed Use of Structure/Addition: 1 f)i/YIti 1 c*i 0Repkcisi 'F 114(pilerete 1(4.A ' dl+wc , "' <br /> Anticipated Start Date: (Home/Cabin; ommei <br /> 1 Business;Bedroom;Deck;etc.) f x <br /> C7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: " <br /> r --,, <br /> r <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to V' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z --G (J7 <br /> home additions,an <br /> d bunkhouses.** <br /> 0 Oil a lac• exi,54..-Al wAlKww 4 ‘P:11 <br /> 19 °4 ?A‘i'l H$ve e 4- Ara e e)riS f7' clr;Lew► <br /> 10 I0 <br /> r}4kilsitte r e eros�on � ass 6e h.11 sl;tde> <br /> VNOfai 04 556.tc. re5 D cttia � <br /> = Fee Re z fl ea <br /> o Check#: C9 <br /> o <br /> Date of staff site visit:7/ mi <br /> .?-47 f?' I Initials of 'te visit staff: ' <br /> / zrr <br /> 0 <br /> /zdla� CA MII <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: < <br /> UPON APPROVAL: APPLIC • T MUST POST COPY OF N <br /> 1 Mil t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> 0 51 <br /> Transcendent: Page 1 of 4 n —' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> G G Q <br /> `moi <br /> a <br /> 3 <br /> t <br />