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LAND USE PERMIT APPLICATION - Burnett County, WI a t~ <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) Ed v„CD T <br /> \ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 i; Q <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `J66 <br /> 7e Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150co <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 °G7 E <br /> Filling/Grading $150 Boathouse $500 r- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 — , <br /> C4 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w b <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 /> /1 hde.r5O -) ° + <br /> - k <br /> AAProperty Owner's Name: /Q!�) o. <br /> cifII, <br /> Property Owner's Mailing Address: (i' 3 r5 ) /y E ire(�C7t/ AiN *5- 14 3 0 1 <br /> � �--- J City / State Zip a II <br /> Property Site Address: J5O d> -Tabor /o-ke br t Ve E. <br /> cn <br /> 4 <br /> Contact's Telephone Number: 3 n- 50 -O 2J) to o N <br /> Contact's Email: <br /> b� iySterol V, Oyy-xx.A.A„ COm d <br /> co <br /> Legal Description of Property: .. <br /> N '-o <br /> Section#: IF Town#: V/A/ N Range#: iS— W Town of: 51,Gr/ 0` _ °` <br /> B' <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):(/9,2—��lf e, C, —��� <, <br /> Proposed Use of Structure/Addition: G4 i;\.4,1 e- 5 1-1 . p 51 0Y.4",e- <br /> Anticipated Start Date: g ^1.4---V / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> *f..7:3 c4d <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �— C.31**The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to ‘11 ~-*' <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z 1j <br /> home additions,and bunkhouses.** z <br /> (V1 ek all 5e-b gLoks <br /> J0+ cci,r ht,014,1) b R D I <br /> s Fee Rec: �5 1 '; <br /> y Check#: 119 t <br /> `o <br /> 11 <br /> Date of staff site visit: 8/3I'I Initi. s o to visit Ilk staff:_, D �Q� <br /> fifil <br /> APPROVED BY LAND SERVICES OFFICIAL: � ' ,, DATE: f3/5/021) t.-- ^ <br /> ci fes" �U <br /> UPON APPROVAL: APPLICAN . UST POST COPY OF ..... <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q <br /> Transcendent: - Page 1 of 4gi jlf <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 J <br /> a <br /> K <br /> -9 <br />