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LAND USE PERMIT APPLICATION —Burnett County, WI . b <br /> Applicant Complete All Sections Below This Line 5 <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> d � <br /> *-><Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 am` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -- W <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 • 9%).---2 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° fN Ilk <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v, <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. Pa <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 /> r 5 <br /> Property Owner's Name: j e I, J 'C o 0 <br /> Property Owner's Mailing Address: gOto 1-/o/& Ail r, .57,R14-/ ,/40 5-Sie g c .7,.,_•/ n City State Zip a i Z <br /> Property Site Address: '/c1 , K S-1 l,l:;.,j..r• w. <br /> to <br /> Contact's Telephone Number: '1101- ?Co'7- 23)g (%p,,.t IC'4 •r ' <br /> o <br /> / a � <br /> - <br /> Contact's Email: .tbeJnA4�e Prl�.(r(` 1C,44, s, tC1 e I <br /> J C; <br /> Legal Description of Property: jet- 4,", ..cQ s.L,�„ f/ - <br /> �; aSection#: 3 v Town#: �t) N Range#: /6 W Town of: 04 Kle„e� <br /> 5 <br /> *Attach additional page i needed or lengthy description OR attach a copyo the.•••8R attach tax system property page.* <br /> * "� <br /> P S f T g Y f �_ Y P P t3P 8 q <br /> , ) ,7; <br /> Tax ID#(1-5 digit number;found on tax statement): /11/053 /3'S1) <br /> •1 abi� <br /> Proposed Use of Structure/Addition: ”' <br /> Anticipated Start Date:A/P✓✓ JS? Z0 2/ (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor:i2eofr�,tev/ LLE)' AI 4L,,`i•• /r. Sewer Installer:41 frec)A � 1• Ste' .+�" e je t I ,,,, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 4!ti ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <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.** <br /> k ()1 ee-c- U 3e4-64IS <br /> o ,„„m, r,sq ra - e Cee. W beJeco s ee- <br /> lb o6 and N -al - 6 <br /> P • <br /> ' Fee Rec: — <br /> g 60Shea 5 '1 6( H/'J+e�/) ka , on �� �e6 d R� - Check#: .28 <br /> 5{; be rerhov i?./1/? m <br /> Date of staff site visit` i l J` i?"' ( I 1 iti. r site vi 'r to I> a <br /> • "site <br /> ' 1--` <br /> APPROVED BY LAND SERVICES OFFICIAL: ', / ' DATE: 1 I/1B(.21r- • <br /> sw <br /> MI <br /> UPON APPROVAL: APPLICA %'' UST POST COPY OF .m m a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCD o <br /> Transcendent: Page 1 of 4 m Q <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 <br /> CD RilL <br />