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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' <br /> PP p 0 , <br /> Permit Types and Fees:(Please,check appropriate boxes) O.-,-,, <br /> Dwelling/Principal Structurecik $300 Addition/Alteration to Dwelling/Principal Structure $200 %) <br /> Commercial/Industrial Structure Poi $300 Addition/Alteration to Commercial/Industrial Structure $200 F. <br /> .. 6 <br /> If Sx k Accessory Structure(Garage,Shed, �,$ 3ff Addition/Alteration to Accessory Structure $150 'N F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G) Al 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r <br /> o -11 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> c4 <br /> *NOTE:After-the-fact permits •ermit a•uired after construction has begun)may cost up to three times the normal fee R. <br /> . . • .- owers&Signs require a different application orm;see corres.• . . ... . i• ,an. ees. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> l ` o z <br /> Property Owner's Name: Gis�J //�'(s �ti�/< <'/� 'z <br /> Property Owner's Mailing Address: //� 5-60 f3 _s-/,c /G// DChL, ' 1/ % 5 " 'i o $ o r <br /> / City / State Zip $ <br /> Property Site Address: -S4 y,....„._ '' cn_ <br /> Contact's Telephone Number: 7/ 5 _ k-C —,793 Z o E t <br /> f <br /> Contact's Email: o <br /> y <br /> _�" r LQ1I / ., <br /> Legal Description of Property:5 w 5W vx S J O t' vv-I <br /> ,, IIN b <br /> Section#: 2. 3 Town#: LI 0 N Range#: I W Town of: ehk 41,1 °_. °° <br /> 5 <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * ro <br /> P 8 f f 8 Y P Y P P t1 P 8 P <br /> Tax ID#(1-5 digit number; found on tax statement): 135 7, .. :t <br /> Proposed Use of Structure/Addition: C 46, Cl/ i' — 5 hr c-` a z `� <br /> Anticipated Start Date: 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ') t r 5 <br /> Building Contractor: Sewer Installer: T <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 /> d Neec0( �-}bc.c s <br /> ep NCA- e( h. k 1 he b,'on <br /> Lod+ ath.;e7 neele� of' seed c Ia✓►k iy 6i I j2 <br /> E3 Fee Rec:5Q-D <br /> 4 Check#:t2//F <br /> rn <br /> v <br /> Date of staff site visit: 12-I 3/21 Initials of site v'.it s +: 1, L a <br /> ! - �� �__�..oJ <br /> APPROVED BY LAND SERVICES OFFICIAL: li , A.i.,Li DATE: ( /.6/1 <br /> 151 <br /> UPON APPROVAL: APPLICANT ' UST POST COPY OF m o <br /> giiii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - 0 <br /> ' <br /> tv CI <br /> Transcendent: Page 1 of 4 • 1",.a C4 <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 - <br /> _ 1 Rill <br /> .. J <br />