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• <br /> ' LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> a. <br /> 7. <br /> E 11•4 <br /> Applicant Complete All Sections Below This Line a' c <br /> Permit Types and Fees:(Please,check appropriate boxes) a r}l <br /> Dwelling/Principal Structure $300 >Addition/Alteration to Dwelling/Principal Structure $200 :: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `"pQ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ci <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 CD <br /> 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - <br /> r. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e° <br /> , <br /> Filling/Grading $150 Boathouse $500 <br /> r. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 . <br /> o, <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 not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 'O <br /> Property Owner's Name: t3/2/9/..)44--y 6, 5.74-644-7R/ o <br /> /E,JEN <br /> Q _ <br /> Property Owner's Mailing Address: 8 76 ,819 y/9/ i) Coto2/ PRA//1/t- MN .33 397 o <br /> ��3 /3iv,G/2EN ' City State Zip $ <br /> Property Site Address: ,S//fit%✓ Wf _5-ya7z E n <br /> Contact's Telephone Number: S .2- V‘,..5--153-6- -` <br /> & o <br /> Contact's Email: G S4etc/0 CGl 1 1 S 7 7 N4 '12 ' _ a <br /> -P.,' <br /> Legal Description of Property: SiC ,ZO Trl 38/2 /' /V �L S`7. 5G/N� <br /> / �/7/V/,E4S a <br /> Section#: ZO Town#: >'� N Range#: / W Town of: as °° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* °0 <br /> d <br /> r <br /> Tax ID#(1-5 digit number;found on tax statement): 2 3 / ,„ <br /> Proposed Use of Structure/Addition: S£j9—C4/Y/IZ _ RteRt,4//0/1/ Crs-N '4 <br /> Anticipated Start Date: J,i /)j 2O t (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: S,24'F Sewer Installer: Ai —/1/O e//dA/6F-S q,..) ° <br /> e- <br /> ,-3 <br /> tw 4J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , •-0 <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 VA <br /> home additions,and bunkli <br /> ouse .** x <br /> 0-roti-N( dweti‘ /left cei ; beieroin5P� <br /> silty 651a. ,1 <br /> ghee-i-- all 5eb..L.kS <br /> o Fee Rec:a2oD v <br /> Check#: /3/ <br /> 81 '1 ?- I 1---- <br /> zom <br /> Date of staff site visit: Initials �,iite visits + �_- <br /> CA <br /> APPROVED BY LAND SERVICES OFFICIAL: di- m <br /> .. �4 � //� DATE. 8/J�/ m <br /> UPON APPROVAL: APPLIC ,' MV ST POST COPY OF ; z 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z -o C = <br /> Transcendent: - Page 1 of 4 a' Ce <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 a _ <br /> rna <br /> 3 <br /> -o <br />