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, LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line :' - <br /> i <br /> ' <br /> Permit Types and Fees:(Please,check appropriate boxes)' r n <br /> Dwelling/Principal Structure $300_ ? <br /> Addition/Alteration to Dwelling/Principal Structure $200 `c"'` <br /> Commercial/Industrial Structure $300_ Addition/Alteration to Commercial/Industrial Structure $200 E. <br /> )'Accessory Structure(Garage,Shed,etc.) $150_ Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < <br /> Filling/Grading $150\ Boathouse $500 0 r- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r <br /> cn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. m <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. FS <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. l, <br /> CA,- <br /> ky p r ' <br /> Property Owner's Name: itC 01,- i • i 1 ' , stn I 0 ° z <br /> P, m <br /> Property Owner's Mailing Address: M al t— G ct4.P C 'V R�t4 .i r �N � LY£ <br /> F <br /> �' I i City St e Zip .o <br /> Property Site Address.:1;A • � 35-/'1 3 3� b� �J�'br I� n <br /> Contact's Telephone Number: 5 C - 11-5-5-04-{e <br /> 15S c <br /> Contact's Email: "5 L,Ic 5-z-9 c 6,,„-,...,') ,Cc,-- <br /> Of- <br /> d <br /> Legal Description of Property: S22, <br /> CS j jet c k Oi— jk.C' <br /> r N b <br /> tl <br /> Section#: 7 Town#: 3 i N Range#: 1 et W Town of: f.Je,S'- /l w�.,L I�/ 0 <br /> 5' <br /> o-0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> N <br /> Tax ID#(1-5 digit number;found on tax statement): 3 s/L43 3' <br /> Proposed Use of Structure/Addition: 1". ,1-- "' <br /> Anticipated Start Date: 0 X <br /> p r�;^Z ( (Home/Cabin;Commercial Business:Bedroom;Deck;etc) <br /> Building Contractor: Amtart c,i, s}e.e.I (or f'or+.5 Sewer Installer: W -- -- `` <br /> _i , W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY VI <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 l/ � � <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes,manufactured z - W <br /> home additions, and bunkhouses.** x iS <br /> 110 (a e e e;4 1 1 S&FY-S. <br /> 2N04- u64'6ch fit-1kk spa <br /> dCo, iter i ,'�5 be,0 X <br /> x Fee Rec: � <br /> ti.i5 Check#: i/G,D <br /> 8/0/21Date of staff site visit: Initi o site visit staff: a <br /> 9/1 /2—( <br /> APPROVED BY LAND SERVICES OFFICIAL. //". 9111.9-. DATE: ID .o � <br /> UPON APPROVAL: APPLICAN UST POST COPY OF g (--- <br /> 23 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTPOale <br /> a) <br /> Transcendent: Page 1 of 4 w <br /> Laserfische: Burnett County, W I Land Use Application —Rev 12/2020 , 3 <br /> n RilL <br />