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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes) o. <br /> 4 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 fl tf\ <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 '� O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 VI E <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> \ <br /> n ZDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 0 <br /> Filling/Grading $150 Boathouse $500 r- )'J <br /> o rs <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CA <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. `s <br /> Ef <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 20 (`4 t pie_,, b eI S z <br /> V <br /> o <br /> _,+ <br /> Property Owner's Mailing Address: kO�7A _ 1544 1�lz / 1,..-r1VJOOc:W+/tf %AA 5512--/ °o Y <br /> �" , I City State Zip W <br /> II <br /> Property Site Address:Z19 �crw ' �,y.�Ct l�.� <br /> , W� `�8�3 _7. <br /> i rG <br /> Contact's Telephone Number: 024,45-4{,05($v—e-r 2t1/ L'Z-'13o-33 5 Lowntc) o <br /> 1 a <br /> Contact's Email:,Me.tirn@l, GOJrvt-rjbnictea<Drn / Rdbt(OZQCOMCe4 ,rle " o <br /> iFi' <br /> Legal Description of Property: 1..-v � ' 'L GS 0 . X11 .. <br /> ' <br /> C7 <br /> Section#: 25 Town#: 40 N Range#: 15 W Town of: 3a Sorl I °O � <br /> 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax systempropertyPaXe.* <br /> p 7V <br /> Tax ID#(1-5 digit number; found on tax statement): 5-7,0_39 I ) <br /> Proposed Use of Structure/Addition: SG[t, 0.- C,dt.4 ,/fio J. rn <br /> Anticipated Start Date: 10/1 tat)2--11 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> !7 <br /> Building Contractor: It CdJn WTI &Via PIC- o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: !--. 6-* <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to W <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** a <br /> 0 (Ylee-c---c,1( 5 - P ,. <br /> • <br /> 0 I <br /> k-✓Cir. eKce 4 beci/e°145 Per <br /> " fJafi�,40 S,5- ,ii i/ ! e(14d,A5 5LAr� �e We-6;d eXpan*,m <br /> 302s_ Fee Rec: <br /> v Check#:93 <br /> glaII 1 �LTr <br /> Date of staff site visit: Initis of to visit staff. z <br /> APPROVED BY LAND SERVICES OFFICIAL: ti - #.,411111K DATE:DATE: /b/�c7`/Z( < r O <br /> ff <br /> UPON APPROVAL: APPLIC • :'/ UST POST COPY OF W m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo (=> ttj� <br /> CD e N <br /> Transcendent: - Page 1 of 4 `2 � <br /> .ns <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 < g <br /> zr <br /> LL <br />