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LAND USE PERMIT APPLICATION - Burnett County, WI ai 4 <br /> Applicant Complete All Sections Below This Line 0 ��., <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> ► <br /> C7 <br /> ;4, Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> _p E <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 tAR <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500, r '4/ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 -1 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. @ 3 <br /> r' 0. <br /> Property Owner's Name: kt y\-\-4'&-erh G ( i lAr) n c <br /> mr <br /> Property Owner's Mailing Address: )..a %.4 CJ-1' idd� 14 L V) ///l rw, IA -�51 -cs a 5 <br /> .S fo Is �o�C`e e� City State Zip $ <br /> PropertySite Address: e Je. cn <br /> (AIS <br /> jggy3 <br /> Contact's Telephone Number: 715 -- 553 I I a 5 r --7i5 -553 -- /I d to ,c/c) <br /> r- [ <br /> Contact's Email: r b 5 h p P$ t )c1K11 G:rLd ► t")5 -i <br /> Legal Description of Property: SE S(1 S 2 I q()A -- k 16 (..,,1 <br /> N <br /> Section#: a 5 Town#: 4 C N Range#: )(o C'p0 ...rb <br /> W Town of: kjef c d O° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> V <br /> Tax ID#(1-5 digit number;found on tax statement): 13 1,7& 6. <br /> q <br /> Proposed Use of Structure/Addition: 14 c VV) e•.. Os <br /> Anticipated Start Date: 3-,Z A (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 4 il <br /> Building Contractor: Ca-116d(\ CO A.6 4i is clic' t?/4 Sewer Installer: L- VI n5 ' c-ni416t tv.J d <br /> -i lb <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THUS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: f•- t--' <br /> *The applicant need,to contact their l.I)t'Inspector to determine if permit is,seeded frogs them prior to 1 <br /> ANY construction taking(place for any dove inns,dwelling additions,manufactured homes,manufactured z D <br /> home additions,a d hnf�arg.# ptI►' � rw-1-� <br /> iz) occeej 3 bQC(09 pet,- 5-N -a1I -303 <br /> gx '! ' 1,. <br /> s ivy- 4or Lonkono4-40 be. V7e0 fD(- kt40140 "'il•11t) d i nAACe- <br /> Fee Rec:# 157) <br /> c S 7 <br /> Check#: l 1-j . <br /> tiC <br /> Date of star site visit: 10)i9 I p Initials i f site visit sta����� r. <br /> APPROVED BY LAND SERVICES OFFICIAL: 1 DATE: lid/pl <br /> Ia <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r -� <br /> a ..a — <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 0 -4Oil <br /> Transcendent: - Page 1 of 4 i;g- <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 ''; �. Fill <br />