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07, <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 0 <br /> iv <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300_ Addition/Alteration to Commercial/Industrial Structure $200 `J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 nO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 v ' <br /> I/ Deck/Stairs/Patio/Retaining Wall/Sidewalk (/Bunkhouse $250 C) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 cr r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ^ p% <br /> cn . <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 5 <br /> a IP <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: <br /> i�Qit e"ihe ('ay/ A-tic -/ -ja4'i 'ail g z .., <br /> 0 <br /> . ie Ii4c1 lafanotai A/ 5:5-0e? <br /> Property Owner's Mailing Address: lei0 /20 c <br /> 'h 0. acc Qhs ee- City State Zip <br /> h <br /> Property Site Address: c/ y E. �v„ <br /> Contact's Telephone Number: ( 6v6)k Ve —6 V66 � .° c <br /> Contact's Email: 0171/02-2-W' �%I n- gi c '—4z . Coo a. <br /> Legal Description of Property: ,4/ a,-C2/ ale /atid�pilzi /,n (:r e,, ,,e- t. 2/ 7 <br /> o o <br /> 0 <br /> Section#: 3 Town#: .3 9 N Range#: / W Town of: sie <br /> *Attach additional page if needed for lengthy description OR attach a of e deed OR attach tax system property page.* <br /> * <br /> Pg gY P 1Lt/-1 lS P P YPg t7 <br /> Tax ID# (1-5 digit number;found on tax statement): J"� <br /> Proposed Use of Structure/Addition: Aen.&Aouse 6K C' Glh' �S'/CIS:, - v) <br /> Anticipated Start Date: ()Cf Boz <br /> l (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> self -�.\ <br /> Building Contractor: 4 Sewer Installer: JV <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 dwellings,dwelling additions,manufactured homes,manufactured z —Z., <br /> home additions,and bunkhouses.** Po _ <br /> {lee x.11 s <br /> çoIou) cc ti si3,H,iik se- col/ev I+ rel•c-6di-s <br /> — 451, <br /> s Fee Rec:� — <br /> �� f � Check#: rJtl <br /> u 1 rn <br /> 0 <br /> Date of staff site visit. !l I ' ' f s'l visit taff:.� / a <br /> Z' <br /> �' r /' ° <br /> APPROVED BY LAND SERVICES OFFICIAL: i' / �j DATE:�lI a l < —� <br /> fir <br /> /� y 3y <br /> UPON APPROVAL: APPLICAN , ST POST COPY OF a <br /> a <br /> ..3 :Ls <br /> > (/)w c <br /> (7) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> r- (1) `,.. r., WO <br /> •< N n W <br /> Transcendent: Page 1 of 4rxi CD c 1,...) <br /> Laserfische: Burnett County,WI Land Use Application-Rev 12/2020 < 9-i'< <br /> m <br /> cn 3 <br /> LTJ <br />