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,-"'.-- V y,/ V t-Cr v v /i Clfi T - r . c , r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 6 tN <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t. 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4) o <br /> ( Accessory Structure(Garage,Shed,etc. $150- Addition/Alteration to Accessory Structure $150 � g <br /> g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 o O <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 a, <br /> A, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact perm' •- •uired• - •• •'•n has begun)may cost up to three times the normal fee. - ^ <br /> mmunication Towers&Signs require a different application form;see corresponding app:cation,an• ees. x� .%. 4 s g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. N o <br /> Property Owner's Name: T t'`ow. c'' S - ( •vi 4-c ex / Tarn cva. MQ I 8 <br /> A j M � <br /> Property Owner's Mailing Address: �i ( Z X ; 4 N:t-. Vv 1✓' :h S et c,(- S s t1 , n n <br /> Cit` State Zip c I <br /> Property Site Address: Li 0 14 0. / c14 K 1'( V c, v\In-tr.-5 Jim.Jim. • _a <br /> - <br /> Contact's Telephone Number: � "- / 2 �i - `� 1 d <br /> Contact's Email: At,,tt_k ( 2... s. a O V} l Le lC- , C L on O 3-066'415°0 N <br /> o. <br /> Legal Description of Property: Lot t 8 Po-t'c e 1 ID 01-Q3 2,-2 -Li I-lkb-35- ', o <br /> P <br /> Section#: 5 5_ Town#: LII N Range#: ( to W Town of: 13 U(Ile k4 C o w,N) -Su)',SS -. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page* cn <br /> .. <br /> 3 3 s g 80 -3 <br /> Fax ID#(1-5 digit number;found on tax statement): , <br /> A f <br /> ' <br /> Proposed Use of Structure/Addition: S A'ei rte-b Q C®P1+O.r Q f 1 S i-. 6' r` T 7 6.a <br /> Anticipated Start Date: 'N4. (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor: 1.; Sewer Installer: 1 <br /> I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY lz <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to j <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** <br /> d (YIP. 411 Se- 15 <br /> € Not- cof iw.eru ,l hob,Jr- -iii <br /> ti <br /> Rki 01,./b-F be it lec -d , 1i*11=q s -.{z,4 4 q,/1 4-iS. g <br /> Date of staff site visit: 2-I 1 /2- Initials of 'te vi�staff:. 04, Fee Rec: /5616- <br /> Date <br /> d Check#: //06 <br /> APPROVED BY LAND SERVICES OFFICIAL: // DATE: ?/t� �. <br /> f fC7 <br /> UPON APPROVAL: APPLICAN V UST POST COPY OF j: guil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 3 z <br /> a N_ RI <br /> Page 1 of 5 " 0 N ,:=2Burnett County, WI Land Use Application—Rev 12/2021 o <br />