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I LAND USE PERMIT APPLICATION - Burnett County, WI a ' <br /> 7 isj <br /> Applicant Complete All Sections Below This Line 6" v <br /> Permit Types and Fees:(Please,check appropriate •• -s) °d 0\ <br /> Dwelling/Principal Structure 30. Addition/Alteration to Dwelling/Principal Structure $200 <br /> , il .. <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 pn <br /> v� <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 O <br /> ' Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> ' ti tl Bunkhouse $250 <br /> ,1 <br /> vDri,Deck/Stairsveways/&Campground Structures `S12 WI State Statute 59.692(1v)Structures $350 ` <br /> ° PI,7 Filling/Grading $150 Boathouse $500 C- <br /> o , <br /> e Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> a7 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. P <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: EQnec,� F 1' hon G � r eia\ l�•1 ° o04 <br /> PO box \,5 5S2cN' u � ' lot 5 /83o .Property Owner's Mailing Address: I' o <br /> X51 `(�1,t Vro, Rf3 ,Ci Stat� 6O <br /> Property Site Address: i cJJ 48E. � <br /> � < <br /> Contact's Telephone Number: `7& c - 35'I -8C05 o <br /> • <br /> 51 �riecosst 0� r .k\, Ccr� a ok <br /> it <br /> Contact's Email: � � o <br /> Legal Description of Property: 1.,61- I csn Va3 9G C#3`ll ) cw65(6)M `98 <br /> ,Jo vc <br /> Section#: 41' Town#: -1 I N Range#: I kb W Town of: ,...5_,01 55 =_ <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * °G <br /> P S f f g Y PQY P P t1P 8 - <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> .3c31\U�/� F. N <br /> Proposed Use of Structure/Addition: NOrne.CI' VlJt�l-) t 0a. e ).,), `� <br /> ,_, <br /> Anticipated Start Date: o <br /> p S�� (Home/Cabin;Commercial Business; edroom;` Deck;etc.) x <br /> Building Contractor: R C Q_'/ Ex f Sewer Installer: l�oPKLts <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 <br /> ANY construction taking place for any dwellin s,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** <br /> 0I eeA- cell 5C-4- <br /> d.. C2,rai.,e_. vorl- c c,r k 4.4 ,,,,,,q& 1.1c4,10 11-Al 04 <br /> ,Ne ekc'e ed 3 rc`v"6 1 7.--154-)-yr <br /> go V z Fee Rec: • �� <br /> Q �/ Check#:3:3.. 9 <br /> Date of staff site visit: 9/31;I e/'"' 2 Initia of site visit staff: ' <br /> - <br /> PjP3IiA / . / ?. <br /> APPROVED BY LAND SERVICES OFFICIAL: �t� //�%� DATE: 0i W c'' <br /> f,'. C) . <br /> UPON APPROVAL: APPLICAN '.f UST POST COPY OF t.. <br /> (7 N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 7' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 �� <br /> > <br /> 3 <br />