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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d las <br /> Dwelling/Principal Structure $300 XC Addition/Alteration to Dwelling/Principal Structure $200 F (J'1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �q , <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `� F.2Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 F Vv <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° , <br /> Filling/Grading $150 Boathouse $500 o r <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. P <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 <br /> Property Owner's Name: jy\\ ` rs \'v wA;I &b c E. _ z <br /> Property Owner's Mailing Address: 3 Z 3 '7 50 M m U 1 Yl�1)LA- k-1 i J9wD (b 9021, $ <br /> CL <br /> City,r State _,ZipQ p <br /> Property Site Address: Z 5 Z 51 Zi-20-1- ' $\A L1,Ti � ) �t ,PJ\ez Lull > F. <br /> aQ4 V� gtsOma. l\s -51::)J0--2 A3 S C <br /> Contact's Telephone Number:Q U b <br /> o 1 fA <br /> Contact's Email: 'cc\ 6 • V L'.t-e r s O I.. �\A" t q, v40411 • C � d <br /> Legal Description of Property: 1-©T 'I C3(V) V U ? ' 41 71(7 y 0 V w <br /> Section#: i <br /> N ac <br /> Town#: AC) N Range#: I W Town of: 5C0 r <br /> cx <br /> *Attach additional page i neededfor lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * <br /> P S f g Y PiY P P h P g P <br /> Tax ID#(1-5 digit number; found on tax statement):, I { t., 16 <br /> Proposed Use of Structure/Addition: -�c,1 Z.00 M l Z`A�N C4 <br /> Anticipated Start Date: .ser k ST- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ox <br /> Building Contractor:-Pe_:_\--e_ (AVsk CDk SS Sewer Installer: SC CEXSS\---V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <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.*,* Po <br /> j (tee- cti <br /> secks NL. � J <br /> /9 Owe-i li f1.a egze 3 beO�"oorris <br /> zFee Rec: ^l42 <br /> o <br /> m <br /> Date of staff site visit: I0/7i Initials o site visit sta y Check#: /bIL a <br /> 0 <br /> '/, <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> �� " �� DATE: z0������ <br /> UPON APPROVAL: APPLIC A .' '�MUST POST COPY OF to)a 0 <br /> Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o ab c=3 <br /> Transcendent: Page 1 of 4 Q... <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 iUuu <br />