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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 3 ,46 <br /> Permit Types and Fees:(Please,check appropriate boxes) , ° 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> w •.)•► <br /> ommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> \ � <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \,0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 - 54 <br /> - <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 (,, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .L`'' <br /> . <br /> Filling/Grading $150 Boathouse $500 1% <br /> 0 <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. t <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - M <br /> Property Owner's Name: (...--e-�A I at I- C 4/Ln b 1 V a F F z G <br /> sso6� <br /> Property Owner's Mailing Address: �l 9?ii j�,d j/I S'. Lc) /Q o 3 P1 Devi- �� F <br /> ` l ! City State Zip b <br /> Co <br /> Property Site Address: Cy 3 <br /> I • <br /> Contact's Telephone Number: 9 5 - 9.,/ 0- (O -7 4 0o y <br /> C <br /> to <br /> Contact's Email: y , /L G F r (o 9 I/9)-I Ov . &a vl'". d <br /> Legal Description of Property: /'D SS V W\,S P).A/IL S Lo <br /> Section#: 21 Town#: . °Q <br /> 3 pNN Range#: R J (p W Town of: yj'j.{�.t-�V c�/� <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 to stat;me t): / Z. 6p Li <br /> i'�fDrat l FRo,IT Pan-t.ti o.,c,44 JAI fn.,daT d- <br /> Proposed Use of Structure/Addition:,Qt44.s or. a,v Qip(,/C - A Is O V-c-T4 4.1444 ,19 n,A,.e <br /> Anticipated Start Date: C i 1 /2-1..... (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> ./ = d <br /> Building Contractor: CLt),A14?t Sewer Installer: <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 .--0 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.* Pzi <br /> d Meek a<< 5 ,bu <br /> 8 &Atte. l no d •c-I,( h 'lG.n )tubi' -11 '? <br /> 3 Dvveb ►rot- -iv eK(eec a- wit..cm, ?er SAI'J- )7-!q5 - 0 . <br /> 73 <br /> x Fee Rec: 0 ti <br /> y Check#:-]-j*, <br /> rn <br /> Date of staff site visit: 2.1112'I?? Initials of site visit staff: i't t. c , <br /> APPROVED BY LAND SERVICES OFFICIAL: iNeds <br /> 6;;, ...7#7A.DATE: "I/I3/? <br /> D <br /> UPON APPROVAL: APPLICANTMUST UST POST COPY OF 1.g <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT In " 00 <br /> o <br /> cp <br /> Transcendent: - Page 1 of 4 � <br /> C4 <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/20203. . _� <br /> s.K <br /> b <br />