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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line '.: F <br /> Permit Types and Fees:(Please,check appropriate boxes) - `S 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 U\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Gl F <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) op <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 IP <br /> Filling/Grading $150 Boathouse $500 r' N <br /> c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r <br /> v, <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 /> r g <br /> Property Owner's Name: t C...).101., (_, 5 P6 �- c <br /> 1�a-3 a, L 4 ST Pi A t &i) 553 o4 o <br /> Property Owner's Mailing Address: o <br /> City State Zip ' l'\ <br /> Property Site Address: (i2 I)l°l '"3Tt.x-,8 26 L GraSTEg_ -i- 5(4 q59 3 n <br /> Contact's Telephone Number: Cl Sa—.4 5 — 4:67(o 3_ o <br /> Contact's Email: still l�—'SP'CNL'�R�Cpw.C►rySc- N E t a <br /> Legal Description of Property: V1,'V 1C. S <br /> N ao <br /> Section#: a--.1 Town#: (40 N Range#: i U W Town of: OA(L(AkrQb <br /> 5' <br /> cm*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> U. <br /> Tax ID#(1-5 digit number;found on tax statement): t.,37 Sa <br /> g. <br /> Proposed Use of Structure/Addition: c/' n-A&C `� <br /> Anticipated Start Date: w <br /> p OCT�� a0 01.1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � x <br /> Building Contractor: Sewer Installer: ___ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: l- v <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to th <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** x <br /> Meek a.11 ` <br /> ie NA- kv( 11,4410,4 fib' .vf' <br /> xFee Rec: 1 412 <br /> " 2 <br /> 8/�0/O-I L. Check#: <br /> Date of staff site visit: Initials o site visit staf•_,��. z <br /> APPROVED BY LAND SERVICES OFFICIAL: CI ,% /�� DATE:N713/24 < �OJ <br /> UPON APPROVAL: APPLIC • 1' MUST POST COPY OF Fi <br /> a , <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° e G' <br /> Ml <br /> Transcendent: - Page 1 of 4 , 0 0 N <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 m N Q <br /> ,c <br /> IND <br /> J <br /> I � <br />