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LAND USE PERMIT APPLICATION — Burnett County, WI g b <br /> N <br /> Applicant Complete All Sections Below This Line ;' <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> q <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 V <br /> 0000 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 CD <br /> c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o Q <br /> Filling/Grading $150 Boathouse $500 r <br /> r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 , <br /> cip <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 <br /> �*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 7 V <br /> Property Owner's Name: tL eev., e_ S 0e foe co.,.Jc z IP <br /> Property Owner's Mailing Address: Li -. I ) A-a, k kr L j o 1 MI/1r142_tCr`_ cl ,hyl,' 5S37S $ <br /> City State Zip <br /> Property Site Address: ')-B S7 6 lit-2,c AN06,�1 r�<I ( 0Cr\IDuI -,LIT Sy S30 5. n ; <br /> Contact's Telephone Number: q S )-- 4 9 9 - 6 S`l' )_. °�— <br /> n :\-- Q. <br /> Contact's Email: I So fc e__\ cte.(Y ,(PN0^-I � . ( 0(''N ` o <br /> Legal Description of Property: 1-LO f/Y\136.-\ fief j fi c7 V 0'-1 c-1,5 f'r Vt 1 I (cA j e N <br /> 0 ao <br /> Section#: Town#: N Range#: W Town of: 1754 C IC S 0,-\ 5. <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): -7 y 7 SLS it <br /> Proposed Use of Structure/Addition: ('-X le S (Ne(A ' <br /> Anticipated Start Date: A050 <br /> JJv; f— ')..Q I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) }--` <br /> o <br /> BuildingContractor: S� �d� 0 L I i V firP�� Sewer Installer: v <br /> 111, <br /> —3C <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 /> .411'Y construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z <br /> home addi 'on.s, and bunkhouses.** <br /> 0 thee* a<< 3e -Lob <br /> •von <br /> No4- kr kA.m�.n kAl <br /> s Fee Rec: i�Z) <br /> Check#: O.1a 5? <br /> tt <br /> 727/2-( <br /> Date of staff site visit: Initials oI'site visit s :f-• i ' <br /> NC <br /> in4r. DATE: = rAPPROVED BY LAND SERVICES OFFICIAL: • /4 7/ 2 /o2I a U I <br /> rn CD co C <br /> UPON APPROVAL: APPLICAN ' 1 UST POST COPY OF a <br /> NZ <br /> VI 0 NJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z CD c <br /> Transcendent: Page 1 of 4trl c <br /> Burnett County, WI Land Use Application — Rev 12/2020 <br /> Lasertische: - d <br /> rn <br /> a <br /> K <br /> b <br />