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• <br /> + LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 01-,Permit Types and Fees:(Please,check appropriate boxes) a. 1 <br /> d <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 F'Da <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 (O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 co <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °G <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 k. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. IS <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. fi *IP <br /> Property Owner's Name: f,(�Q(�L O � Q J�,� j�m o• �, <br /> Property Owner's Mailing Address: /00 Bo/5/4 '.5,ri ) IAIT seim o Y <br /> n_, City State Zip (0. W <br /> Property Site Address: 910910 Si ![. <br /> a [. G7 7o Sian, it./2- 5€-A-V, vi n y <br /> Contact's Telephone Number: 7/5-,,796,- 9498 i 4, , d tS f! ii) o U> > <br /> ^ L L 0 <br /> Contact's Email: ( C/a-IV7 .hcd/y)Q//ccvrd II <br /> r--- <br /> F' <br /> Legal Description of Property:((f)M e.„1/y7 (/Q5? ( 4'8 p/7 /7158A1/217k/ <br /> N .v <br /> Section#: a/ Town#: 38 N Range#: /7 W Town of: La/VW 5 0 cm <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number; found on tax statement): 07-Cap 4-3$-/7 r2/-$05-Ca-000 <br /> Proposed Use of Structure/Addition: in!Npry)g_, v, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E x <br /> Building Contractor: Sewer Installer: 5tJf <br /> U1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY l <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 ‘ V <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z --t- <br /> home additions,and bunkhouses.** xi <br /> O ems- 4,11 5ettLit5 <br /> OP p we( � 004" ccC�eeer )- b ediborns per 50- ,21 -35,2 <br /> t) hot 4i e. 1col er i .e x a h s�on /t,,'4, q,�7'v ✓) <br /> P J' :i., "' <br /> z Fee Rec. U - C <br /> 7 Check#: /51045 <br /> 0 <br /> Date of staff site visit: 1 `I 1211a 1 Initials site isit s .f f <br /> / I /3/?� m <br /> APPROVED BY LAND SERVICES OFFICIAL: �� DATE: � , <br /> liiiii <br /> UPON APPROVAL: APPLIC `MUST POST COPY OF I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> N <br /> oN <br /> Transcendent: - Page 1 of 4c c::: ; <br /> Burnett County, WI Land Use Application-Rev 12/2020 <br /> Laserfische: - 5i1 <br /> a <br /> L J <br /> Z <br />