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LAND USE PERMIT APPLICATION - Burnett County, WI a g <br /> sr IV <br /> Applicant Complete All Sections Below This Line E5' ib <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e <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 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk x Bunkhouse $250 <br /> Driveways/&Campground Structures ° "v <br /> y pg $125 WI State Statute 59.692(ly)Structures _$350 e <br /> Filling/Grading $150 Boathouse $500 <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. k <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: ' , vey A St�� `s z r <br /> nn ii o <br /> Property Owner's Mailing Address: / �' 1 D t �� C9;1:1-:-b <br /> ale r S 7.1 <br /> c`� (� <br /> 11 rr q -. City State Zip � v 1 <br /> Property Site Address: �� `�-� ! >9 1 p , �� <br /> E <br /> Contact's Telephone Number: S % 2., (09 - S 0 ( o <br /> CD <br /> Contact's Email: p� N S ��� f c Q C, c 1 C �.� o <br /> 5 <br /> Legal Description of Property: 71— /3- cs/ 1/, 2.-? , 3Y1 <br /> o ao <br /> Section#: 3c Town#: 1/€2N Range#: Mt W Town of: aAlegi <br /> cic <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 3.0e/ <br /> Proposed Use of Structure/Addition: C y(VMic' 0 ele. lir h uN i�1 p C e_—_ `1' <br /> Anticipated Start Date: (Ho e/Cabin;Commercial Business;Bedroom;Deck;etc.) h) W x <br /> Building Contractor: Sewer Installer: \t `7 <br /> ti <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 S <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> ome additions,and bunkhouses.** r x <br /> 1114 p ur1'4- 1 con ~7L Me, ?atQye.., Mit et <br /> 131/1h AouSe,..- <br /> t <br /> Cs 6-91101.0 a`) b N K k fI(10 U se- U`€,?c.Il YL.vi e h / 5 04 <br /> ` s Fee Rec: ��r r <br /> 3 Ck elle U�L 14 S}1C-Cl�tef►^ c�/'iN1) ° U11'e/v1F,N7 . Check#:CciS k <br /> ��ula y P a <br /> Date of staff site visit: /0//1/20 II Initials of site visit staff: /T. z <br /> o <br /> -.II <br /> APPROVED BY LAND SERVICES OFFICIAL: 41P. DATE: 08/20 92 2- 1 UN <br /> tn <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF .3 <br /> Sfflil <br /> IGNED PERMIT APPLICATION IN PLAIN SIGHT * `A' <br /> 15- cic <br /> Transcendent: - Page 1 of 4 <br /> I <br /> IRO <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 . <br /> 0 <br /> 3 <br />