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LAND USE PERMIT APPLICATION—Burnett County,WI a <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K "� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 OQ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150si <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C vi <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> VV ` <br /> Filling/Grading $150 Boathouse $500 oP <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a si <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. co <br /> co <br /> Property Owner's Name: D 1i,)son SohnsO rt, -if 021�1Gt.std I Lehr ke z i <br /> Property Owner's Mailing Address: 20(L (O 40 441 t-tV G l,.uCL W t 5 LI 853 Q <br /> !II <br /> _City <br /> i State Zi a <br /> Property Site Address: Lot # II'I Skirl6:A- Land i r On V eT tA)1 5 LA$Yk . n <br /> Contact's Telephone Number: 1 lc Li <br /> Contact's Email: t t •&ybayw�� cow :::::>t co A <br /> co <br /> Legal Description of Property: Lt 1e- TerAoe `o1Kr. 16T 19 <br /> o as <br /> 5 <br /> Section#: 5 5... Town#: 31 N Range#: 1% W Town of:TCC-�v.OAQ. '(€ <br /> ' <br /> *Attach additional page ifneededfor lengthy description OR attach a copyofthe deed OR attach tax system property page.* q <br /> P 8 8 Y P Y P P tY P 8 C7 • <br /> e).k13iia 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 0-,. <br /> Proposed Use of Structure/Addition: 1'10‘11nt <br /> Anticipated Start Date: 0(o f(0 ON I, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> +. <br /> J <br /> Building Contractor: NO( n W O5kt CO 11\11t,4,_ Sewer Installer:?clic,go((\. Elcog 4 i!1 y 1 <br /> A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 5W <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 <br /> i 41-) <br /> home additio and bunkhouses.** <br /> ehee-h4Al Se-I-6 s, Pry ( d ii be <br /> ce8..c-f- co(e.rict:ABTfe4assiii,e2r10,0(,,,c,iit5 et(' 1MN 7 <br /> Fee Rec:��� <br /> 4 Check#: I <br /> 0 <br /> tr <br /> Date of staff site visit:745/ Initials of le visit staff: .102"..--- <br /> z <br /> 0 . / _ ° <br /> e//610-1APPROVED BY LAND SERVICES OFFICIAL: �� _ ,. . Li /��� DATE: < r <br /> UPON APPROVAL: APPLICANT MT POST COPY OF a <br /> . c z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m o <br /> Transcendent: - Page 1 of 4 p 3a N.! <br /> C <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 <br /> T <br /> a <br /> 4 <br />