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LAND USE PERMIT APPLICATION-Burnett County, WI a _ <br /> 5. _ N <br /> Applicant Complete All Sections Below This Line 6' CD 1+ <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7IS" <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 °: <br /> (D <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 7 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I F4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ti--. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v <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. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> r <br /> w <br /> Property Owner's Name: ST6V N Sc err -TAN Kt 0o <br /> a89ial 13hYSHokc pg. N•W JSANTt )J 5-Sos.fd o <br /> Property Owner's Mailing Address: /N o <br /> City State Zip b <br /> Property Site Address: a.q I da. �i�S-1- You 1QiJE2 1W. DANBozi WI. S'i830 a <br /> Contact's Telephone Number: 76 3 6 " 13 3 1o y <br /> CD <br /> Contact's Email: 6 AS. G d R S C n Yi*O t m d <br /> p <br /> . <br /> Legal Description of Property: rikit V N'5 Rt j€& 1 wE5 LOT 51 <br /> N 00 <br /> Section#: 0.7 Town#: `'i b N Range#: 16 W Town of: 0,4 K LAND <br /> 5' <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa page.* <br /> C7 <br /> n' <br /> Tax ID#(1-5 digit number;found on tax statement): y a 1p <br /> Proposed Use of Structure/Addition: (),AQ A a /CoLD $To R.r9GE `" <br /> Anticipated Start Date: 1' 'X0 a (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) k <br /> Building Contractor: T B.b . Sewer Installer: NON E (JJ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY H t� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q"= <br /> , <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to i r <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z .. :Zi. <br /> home additions,and bunkhouses.** 7d --�� <br /> 0 (Ylee4 ail 5c4-1j <br /> 4 ç,( �wrnwnt �ii��,� b 1 /I/a1 O ' i�� 0. �1 <br /> e . -( <br /> , 0.1..;c c6`10 'I' y11eYaeGr Jt re f ef�;7- r�4 CO/ �Ka7dli. x Fee Rec:I'DV <br /> d Check#: I5*ke }- ai ( <br /> cyrt <br /> Date of staff site visit:971 y f 1 Initials 1 site visit staff: i 'J <br /> � al <br /> a - . ' C11/5/ t <br /> APPROVED BY LAND SERVICES OFFICIAL: (. // DATE: )1"n Ififil <br /> h <br /> UPON APPROVAL: APPLIC AJ MUST POST COPY OF �CD Cr) © <br /> 5 n'g <br /> RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g o <br /> Transcendent: - Page 1 of 4 '` <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 ` s ` Nil <br /> CLLL :-.--jj <br /> .y <br />