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LAND USE PERMIT APPLICATION - Burnett County• , WI a.c b <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes) c1 <br /> IDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 gO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 r`' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° <br /> OD 0 <br /> Filling/Grading $150 Boathouse $500 re; iJ . <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(lYear 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 <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 /> o J\ <br /> Property Owner's Name: )Citi J.l <� K�vh O.c^�� '�t,�n) o ' <br /> ` — 11 <br /> r <br /> Property Owner's Mailing Address: (p),41 9e,/t -k,, �� P 1�pS\/ \i'•) ‘ 5-y gct) ° Ki <br /> City State Zip $ <br /> Property Site Address: o,..0 E 1!: <br /> nContact's Telephone Number: t�'O7- 9 g 1 \ 7 .7 c <br /> Contact's Email: h 4 2 1 • 42 •� 1n0 c, C a^� d c. A <br /> Legal Description of Property: 5.e.(_ 3 5 . y\Li 0 Qct 1 L UrCSN\ i 3 P a�3 f <br /> Section#: 35 Town#: 'AO O N Range#: Ito W Town of: 0 A-`FA--4,0,J 0 o. j <br /> cm <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> q <br /> Tax ID#(1-5 digit number; found on tax statement): l 3 1l i ( ' <br /> Proposed Use of Structure/Addition: SAO t A I 4-D Fc-,{G g e <br /> Anticipated Start Date: \3 I i 'li (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> �eVQ s <br /> 13Building Contractor: S e fe‘ Gk N© <br /> Sewer Installer: � l y � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1� p_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n <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 "Ni <br /> home additions,and bunkhouses.** Pv <br /> 0104 414 <br /> 5 kab,.�-�, <br /> MA-11&,( FFk k nen,n5 04 S c1'Neec 44414 b 12./i) )-( <br /> co <br /> z Fee Rec: iv'�� <br /> N Check#: ,3605 <br /> /� rr <br /> Date of staff site visit: �! 0 bo Initial of site visit staff idi o z , <br /> � 842.71P,/ A r <br /> APPROVED BY LAND SERVICES OFFICIAL. �� //ice/ DATE: < s <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ca. <br /> W F <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 6� .... <br /> = <br /> Transcendent: - Page 1 of 4 m r' C <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 2 ffi <br /> m ��v <br /> a <br /> 3 <br /> t <br />