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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CW <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `� <br /> 9.1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> _ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r---, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 p` <br /> Driveways/&Campground Structures ° N <br /> y pg $125 WI State Statute 59.692(ly)Structures $350 G b <br /> Filling/Grading $150 Boathouse $500r IQ ' <br /> Six Month Camping Unit(One Per Year) $100 _ v--Permit Extension(1 Year Extension-Allowed Once) $10011 <br /> 0 ` ' <br /> c <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. rw <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. ro <br /> o 7., r <br /> Property Owner's Name: ,L,/id a r ot <br /> w h z <br /> q o <br /> Property Owner's Mailing Address: 78'0 1 q //4N 4,ey WI 5-yr O o <br /> p rty 7 S0, C fy KnI F City State Zip <br /> Pro e Site Address: . n <br /> Contact's Telephone Number: 1162—(.0 3 3 410 S I o N <br /> c <br /> u I el at- . y....1.,Do. co�^ ° <br /> Contact's Email: P4 <br /> ,01 <br /> 0 <br /> Legal Description of Property: Nw%44�, / SCC Z 8-/ 1".0 n.fI+) y/1(1!RQ..i 9 t I4 t `D <br /> Section#: Z 7 Town#: 6 ( N Range#: /l' W Town of: Ste,..S ) N <br /> '-o°G <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attacch�a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement):3I✓3J <br /> Proposed Use of Structure/Addition: C""t"104-'0- / 144/5. cc <br /> Anticipated Start Date: Self- 2.'7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Fx <br /> Building Contractor: l3'V + 1_aiatwr— Sewer Installer: o <br /> e. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- '-' **-) <br /> 0 -- <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to L <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z U <br /> home additions,and bunkhouses.** Pv <br /> atYleeA-a it 5e-tbacti6 <br /> 0 ep� tir e) b,-rw") <br /> z Fee Rec: 1Z <br /> 0 <br /> Check#: C Sii <br /> Date of staff site visit: 1 1? I�I Initials of ite visit staff: , +� z =CO <br /> o <br /> /�' 9/30/ 1Iiiiii <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: a Gn <br /> UPON APPROVAL: APPLICANT`" ''' UST POST COPY OF A. � N otii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT OM 2 a <br /> Transcendent: - Page 1 of 4 litil <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 (.... j <br /> a <br /> K <br />