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LAND USE PERMIT APPLICATION- Burnett County, WI = 2ro <br /> Applicant Complete All Sections Below This Line G <br /> Permit Types and Fees:(Please,check appropriate boxes) tea. CJ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "4 <br /> $ccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 c <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. i <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: Cy r-+ J n y(-e( S z A <br /> I ' <br /> Property Owner's Mailing Address: I I Lt B(5 4-o. Qct. f I-N..% 31... 4/a f i- -: <br /> ff So <br /> Property Site Address: Jphvl �� ^ ie L ;-3 956 City State Zip tt- <br /> =• n <br /> E <br /> Contact's Telephone Number: 36q- /o- 7 5 3.( o r <br /> c <br /> CD <br /> Contact's Email: £ 5 Cil I( Qyahom•t ✓✓` .- . d <br /> CD <br /> Legal Description of Property:se,re S Z'j-T 3$N-RI7 M/ Sb 6 e e'FS 6MF EXE 970' ., <br /> N -0 <br /> Section#: 2 q Town#: 39 N Range#: / 7 W Town of: Da.,i t(s == Q0 <br /> E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed..-9.44-4, 3 OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number;found on tax statement): �, 5 3e? ,q▪• <br /> Proposed Use of Structure/Addition: rapRrapA.M. v)(�A <br /> d S <br /> Anticipated Date: q} 4 o <br /> p O 3 Z� (Home/Cabin;Commercial Business;Bedroom;Deck;etc. <br /> d <br /> Building Contractor: Sewer Installer: <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ti <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ' <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to (t <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z v <br /> home additions,and bunkhouses.** z <br /> I mee4 ad( 5e- , <br /> N�— I�vtnl4� n.b, i► n el <br /> L <br /> Fee Rec: 50' <br /> ca Check#: )0 l <br /> / f� L r <br /> Date of staff site visit: ` Initials of 'te visit staff: Y ' , <br /> APPROVED BY LAND SERVICES OFFICIAL: •r, i% ,j�� DATE: g/€e7 al w <br /> UPON APPROVAL: APPLICAN ' /QST POST COPY OFrrl <br /> m 1 G <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT2 IV <br /> Transcendent: - Page 1 of 4 M 3 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 <br /> trl <br /> LTJ <br />