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LAND USE PERMIT APPLICATION — Burnett County, WI a .7, r <br /> Applicant Complete All Sections Below This Line g' <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) 01 <br /> a <br /> Dwelling/Principal Structure $300 ddition/Alteration to Dwelling/Principal Structure $200 dFo t' <br /> .Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> .Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150j` <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 y <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 ip <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> o <br /> ' o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 • <br /> cn —IV <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. <br /> Property Owner's Name: P�alt e l�Gi 1-1`��k-G s - z .4 <br /> 11 '' `` , I � p 0 <br /> Property Owner's Mailing Address: 142.S l 09 PI ��` I hew PA LLA. ,-4. WS: S ygak 1 t <br /> _ City State Zip <br /> Property Site Address: 2-(8-1-1(c(e Suer- p , �, ,( � Ji �( <br /> Contact's Telephone Number:0 Lb ) -2...:2-0.— c 9.'3-1 o r, <br /> r 4. <br /> Contact's Email: i...„l ) .5, (.- ut—Ne S QP-n�•v\• (-111-'1,-N p <br /> J { v <br /> Legal Description of Property: Go." �-�Cl tS CD <br /> Section#: \.t3 Town#: LkO N Range#: t 7 W Town of: 3- A <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):, <br /> Proposed Use of Structure/Addition: 'd1N z <br /> 0 '-3Anticipated Start Date: 1,-L -Zt (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) k <br /> !•*) ...1 <br /> Building Contractor: Ava€31'S&r") Ce4n9hrv(51- Sewer Installer:�)0t. � e,•.,,,• <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: --4 <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, dwellin, additions, manufactured homes,manufactured z , <br /> home additions,and bunkhouses.** C��-t+ `'� f t T <br /> , C5rn � be ��Pp uJ11 <br /> D <br /> v✓$11,' not -� :geed I Wroc i1 <br /> 21 <br /> Q� Fee Rec:pc UV- <br /> ee' 5e <br /> ge Check#: �•f(og8` <br /> //Liiai ° <br /> m <br /> Date of staff site visit: Initials ' site visi t;- z <br /> • f. r/7/ c <br /> , <br /> APPROVED BY LAND SERVICES OFFICIAL: ,�i/ DATE:/ 6l/2I - <br /> UPON APPROVAL: APPLICANT UST POST COPY OF . i fill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> aitii <br /> Transcendent: - Page 1 of 4 11, % <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 <br /> rl <br /> ;lit' <br /> , <br />