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r. <br /> LAND USE PERMIT APPLICATION - Burnett County, WI Q <br /> .7. <br /> Applicant Complete All Sections Below This Line 9 'g <br /> Permit Types and Fees:(Please,check appropriate boxes) ▪ _ <br /> I o <br /> Ve Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I d. i' ' <br /> `c NA•1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I '1 <br /> 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i i.l <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 i I� <br /> o I i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i m <br /> Filling/Grading $150 Boathouse $500 I r• 17,) i <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) _$100 I • Ia <br /> I <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. i-1.0-- <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I if I <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I � I� <br /> �' IIProperty Owner's Name: i-i C- A N D MARY TAN Q+A I Sr I z.L3.S;e{, I o � <br /> Property Owner's Mailing Address: 2-%1 1 S 13(9'4 N ER I-A i .£ RD tJ I 5 i,ii S-"i .7 Is I <br /> I ` <br /> City State Zip � 11. 01r\ <br /> Property Site Address: s A M ice -- E <br /> E i <br /> Contact's Telephone Number: ( 9 52-1 9 2_'3 - C)' y3 T c_ <br /> o ;C o g f: <br /> Contact's Email: an anC L-& 1 Sf @ h oYm 'D v 1. C.i V - -co& 4 <br /> Legal Description of Property: L L_ <br /> � 49 3 3 --- ----- 1 I <br /> Section#: A Town#: 4 0 N Range#: I fj ^^W Town of: V 9_---_ tl° <br /> ' I I <br /> I I <br /> *Attach additional page if needed for lengthy description OR attach a <br /> copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number;found on tax statement): rj S 1 6 -- — a <br /> Proposed Use of Structure/Addition: L A QL,L Q DE Oe cxM SY- 1 ce-c-v.w6-k I j <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) I't) o x <br /> Lc 12_�NYS i.._l._ <br /> Building Contractor: v 2S - Sewer Installer: >N A I — <br /> 1 I� <br /> — --- ----- 1 y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: D <br /> I�' <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to IC11 In <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z II0 I( , <br /> home additions, and bunkhouses.** z <br /> A,�.e ►I scf b cr� <br /> -s <br /> v �a fGx a rtS%d✓J M:4 <br /> -: q�'v'l ,.s e,+2e� <br /> G d roofris er I -l 87 1� <br /> z Fee Rec: oo�_ <br /> 0) Check#:32 63 <br /> m <br /> Date of staff site visit:_�7 ?' — Initials • site t staff-,• _ Z ( n <br /> o <br /> I mgni <br /> APPROVED BY LAND SERVICES OFFICIAL: i �/�� _ DATE:_i_?__ __ < o p /� <br /> mc (( )1 <br /> / —_ 3 Nco n V V <br /> UPON APPROVAL: APPLICA MUST POST COPY OF �' <br /> WO <br /> Ty n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i- w= <br /> Transcendent: = Page 1 of 4 m 3 Iiiiii <br /> Laserfische: - Burnett County, W I Land Use Application- Rev 12/2020 m <br /> 0 <br /> D <br /> 0 <br />