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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> • b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) 0. <br /> b <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e <br /> iP <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 b.f." <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 P g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �1� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 N � <br /> Filling/Grading $150 Boathouse $500 C- ... <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> ct <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a �. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> co L r rc <br /> Property Owner's Name: S I a1/4.A k +��` �e Greek t 0` e6�/ fin;e.l iv\C E, l i v-Q5'� z .1► <br /> ck� 9 <br /> Property Owner's Mailing Address: 4 IS- Rid Q R Oc ) O�ccola c IS Syo 2c� o <br /> City State Zip <br /> Property Site Address: ct GO I R)o r}',‘ R i O ett Qoctp .b"ltt4.7 wl C S. S 9&3 0 Ee n <br /> Contact's Telephone Number: 71s-- a as— I a 74 o <br /> Contact's Email: d A h rv\,c e.,1.V r-esk ea Q 3 rT\94 I . ( `"^ d • <br /> s Iiic <br /> Legal Description of Property: g' `/,y $ tv i, 1 .. <br /> N b <br /> Section#: Town#: 40 N Range#: 17 W Town of: \ A ( .10K.) °_ <br /> w <br /> 5. <br /> a` <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertypage.* <br /> P <br /> Tax ID#(1-5 digit number; found on tax statement): a 4 5 1 b . <br /> Proposed Use of Structure/Addition: S Av c qS R. `A <br /> Anticipated Start Date: S i.P f. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ` C x <br /> C <br /> Building Contractor: 'N O'r\ Sewer Installer: �J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 Cn <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 7 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** x 0 <br /> I Klerk 41.0 5&f . <br /> ON A- co.( 11)-tereg4 hitiorm. tc.. 1\ i� <br /> t o -}v W V fQ� I ri <br /> 40 -1c;544 Sheol .- .s r 1 � <br /> x Fee Rec: /.6 <br /> D Pf ack.'fioa -( ✓hie 4,0 �� <br /> Check#: 5/3 <br /> � <br /> Date of staff site visit: 7P9 /3 Initials o site visit staff: At-- <br /> vz rn ' <br /> . <br /> rwa <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:7/3001 a <br /> J v 3 r— V V+ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g <br /> N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 42 <br /> Transcendent: - Page 1 of 4 �. Nil <br /> Burnett County, WI Land Use Application—Rev 12/2020 <br /> Laserfische: - rolLL ' f <br /> v <br /> 4 <br /> a <br /> •o <br />