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r <br /> LAND USE PERMIT APPLICATION-Burnett County, WI c <br /> Applicant Complete All Sections Below This Linecn CD r <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 T.-. ''- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> >e, Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 • EO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 2i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 '0: 3 <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. 'S <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: TiAl.(A Iti )1 t l(t r 14 0,7 _ - i <br /> o <br /> Property Owner's MailingAddress: t l + h '1)N S c <br /> P y ����. �L�C�.'r�i`e�11 /Cjn,c �(.� � v�+� / 515 � d' <br /> City State Zip b II <br /> Property Site Address: i'(Off vi(6-1(G:1-S Lt ce. 6'`(6, O ��„ IP <br /> • <br /> Contact's Telephone Number: 5 I 3g `, . v it(,, / 0 <br /> ro_ a <br /> Contact's Email: rvv,,CA o)i A,- 0,4) r-C G S`� .rv.+ d <br /> Legal Description of Property: kO 2 SC`al A -it `�� U0 I 3 r;,� <br /> kr, , �, L,.6.,; Ct'f g <br /> J N w <br /> Section#: 3 5 Town#: Lt 0 N Range#: I W Town of: J clCC' SO,, =. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0 <br /> rA <br /> 5 <br /> Tax ID#(1-5 digit number;found on tax statement): (p 0 )q <br /> Proposed Use of Structure/Addition: p( )t r G.11) )7) I c:c�- C0 j Ct i i1��, `4 <br /> r t o <br /> Anticipated Start Date: Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E <br /> ° 5 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ti <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: R 1.3 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to r . -V— <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** rPo <br /> 61 V4,4sE- be m o✓Cd {v (h e,i. tii 5,413 ,c,k5 b i 11) 2.). . <br /> a Nc k-4( himerwt A 11 ,6, .h <br /> g Fee Rec: 158 42? <br /> d Check#•: 137 I3 <br /> � rn <br /> Date of staff site visit: 11 <br /> `/3v(/O?"/ Initials of 'te visit s :if: /f1 L z <br /> APPROVED BY LAND SERVICES OFFICIAL: al <br /> DATE: d�11l�)4 . t a cl <br /> < G'—� —i <br /> ID <br /> UPON APPROVAL: APPLICAN° MUST POST COPY OF yIiiiil <br /> Q. Z <br /> �3 <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> m0 O <br /> Transcendent: - Page 1 of 4 A ss iv o <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 rl Ga' <br /> I <br />