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LAND USE PERMIT APPLICATION - Burnett County, WI c `° r <br /> < <br /> Applicant Complete All Sections Below This Line 5' L. <br /> Permit Types and Fees:(Please,check appropriate boxes) a' <br /> )c Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 4 <br /> d <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 `; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> T <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 3 , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. (f) <br /> Property Owner's Name: J 011 4 Lrabaktimse then o <br /> Property Owner's Mailing Address: i t 232C1(ee LAitevvi Ln O a n'pf l r) MN 6531(o 0 <br /> Pa <br /> City State Zip r- <br /> Property Site Address: 21o2lip w, Lipc .tk 1C�it . Pa. filer, \A l 545-501 — ..\-- <br /> Contact's Telephone Number:Jon (111: lc i 2°'1So•c0c2(1 if-A P' Cei i. 'l(c3.913•l 11$ o cd <br /> FD 0 <br /> Contact's Email:i6i) j batlepej'1((y C1,Lf}ln3 QCile40 <br /> sswc .S.rel-40 <br /> d <br /> Legal Description of Property: PLS e Art1 Z 2 V► ( nnJ. e)add Pyr 1-b i lot i- T 5•IN L v <br /> Section#: 13 Town#: 39 N Range#: I W Town of: Rik Lai)witi419b o5- <br /> "' <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPaSe.* <br /> q K1 <br /> Tax ID#(1-5 digit number;found on tax statement): ,55265 . <br /> Proposed Use of Structure/Addition: t)W e.11 i n /Pr WI LA pCt t ,5h u£tort, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 'Jo i rd <br /> 'Jo <br /> Building Contractor: Sewer Installer:54-e-1,f11 -.S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I 100,14)3 <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 <br /> home additions,and bunkhouses.** z <br /> 0 row a1( r u► , 7L o14' U i --2D-o3, <br /> �tnc l ucA4 clot, 1,4196W s`lo lire rep4/1,4ion, <br /> D,Ne II;04 i I ilo vSe flat-40 eK eeJ u b'ov/'t s - 1 pe' 1-N 4-4f , <br /> Fee Rec:3G'1", <br /> 3 Ime2�- G (1 SF��' 0,44i/I V1 �" O3 d Check#:Zy7/? <br /> �-�-I 121 �I L r. <br /> a <br /> Date of staff site visit: l Initials � site vi it staff: i 6 <br /> APPROVED BY LAND SERVICES OFFICIAL: - //1 DATEV s ' t <br /> UPON APPROVAL: APPLICAN .' UST POST COPY OF <br /> 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a G l <br /> 0 <br /> N Q <br /> Transcendent: - Page 1 of 4 ,.c ti <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020TR <br /> rL j) <br />