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c 1 <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line O' G <br /> Permit Types and Fees:(Please,check a a 1 <br /> yp appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 ,Addition/Alteration to Accessory Structure $150 ~O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I 5 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r li <br /> Six Month Camping Unit(One Per Year) o <br /> $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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. w^ <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: M I Q ; 1'aV I V r u. ,(( �g. z <br /> P <br /> Property Owner's Mailing Address: 3303 <br /> "CQ — LE-ave� � yVi h7 <br /> �r / <br /> 0. <br /> , ' . u«v Stater <br /> nProperty Site Address:r, � r'e_d I j t (y r 6.'L't „ <br /> Contact's Telephone Number: 17/516749—/7 3 z, o y <br /> CD <br /> Contact's Email: kfrkulkeghi,On al!, dam d <br /> 07-014-2p w <br /> Legal Description of Property: 3 0 -16 `O Y- o c- Q K-0, 1 o <br /> _;' LdFol N <br /> Sectio#C� qw #��'_ Range#: W Town of: <br /> ��// . , 0 <br /> *Attach additiona page if needed or lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): n9 Yo <br /> Proposed Use of Structure/Addition: S'tDrz e, 0 &L b I n z" <br /> Anticiplt d Start Date: /gyp ?ome/C b�i'nn;Commercial Business;Bedroom;/ Deck;etc.) ,�._ I0pi <br /> BuildingCont actor:EX(lCl/Af 7 J�Les r "u I cl ower Installer: /��N 5 <br /> S-- ins -i <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 <br /> home additions,and bunkhouses.** x I <br /> Mee-I- Ail Se-1-1),c5 yah. ,,►. r�o+ Rd�io e i ��h�, i 0 <br /> .ct , 1 S <br /> 0 No)-- �r L4 '7 b,4- 4 cV1 5Cp . ,ik.� <br /> r f- 014:°u-5 SL.r ce 4o be 4 e. me o( f 4. ,‘,lb4 <br /> S ees be r "c ' e c �,.II a 'a`�xFee Rec:MeiV:Ot4, ur 5 e (0! , <br /> Q ? <br /> u Check#: �j <br /> Date of staff site visit:12/21 � '7 f 1 i — <br /> J Initials site vi 't stta �I 001 z <br /> C <br /> 1 = <br /> APPROVED BY LAND SERVICES OFFICIAL: til 'r • � y/ DATE: /3/?-p' < r- <br /> --. ,:,.7-= <br /> � <br /> m <br /> UPON APPROVAL: APPLICAv" MUST POST COPY OF ';T ® CSS <br /> o <br /> -1 <,= li3u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o ° <br /> < Do <br /> Transcendent: Page 1 of 4 m <br /> 13 S <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 3 '�. <br /> LL----J <br />