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LAND USE PERMIT APPLICATION — Burnett County, WI e b <br /> Applicant Complete All Sections Below This Line . N <br /> Permit Types and Fees:(Please,check appropriate boxes) r' <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 O <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 p.,...., <br /> FAccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ;; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r• 1 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> r p <br /> *NOTE:After-the-fact permits(permit aqui red 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. ,. ` <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o • <br /> Property Owner's Name: I a n n i e L. Te _,, , / z <br /> 'I Q QQ�� n / /� 1i, ,I o <br /> Property Owner's Mailing Address: ��`i wn ed. ,i,e,4o W� 57D2.3 °o <br /> u' w lake- <br /> City State i b <br /> Property Site Address:305 q� �Q„bpr lake- Pri✓fi d�f� WS 5i1g30 E. <br /> Contact's Telephone Number: &,51– aaG- 51.0 g9 •o c <br /> Contact's Email: — 1Ot1niC . - • . • ' o • fled-- a.d <br /> Sec,IR n '' 1 .....-A <br /> - i 3 \ <br /> Legal Description of Property: �#1'333a$0 (N SE' t Li Q�(Sm Vita, P213J <br /> N ^0 <br /> Section#: Town#: N Range#: W Town of: °Q <br /> 5' <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C7 <br /> a <br /> Tax ID#(1-5 digit number; found on tax statement): 021513 <br /> Proposed Use of Structure/Addition: O-cg Gt?_. <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: M ele.4 icil Sewer Installer: 14 A W <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 U\ W <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z LA <br /> home additions,and bunkhouses.** x <br /> I leeA— aU 5e-lbje <br /> Owef 1t' r. ,qgy(- 172 ekcta ? belfrolt5 10er 54iV- 1781 <br /> 5fic l o -hbn was die-ki(/1;nee) b Ins-�.1lu-�'on c1,�� <br /> �� Jt ti\ "X3 Fee Rec: -- <br /> G ''v"e' lit vQ v, Check#:5 2-0 <br /> ) 6 <br /> Date of staff site visit: Lil 1 `a Initials o site visit staff: uj•'(� <br /> _ <br /> // / <br /> ti <br /> APPROVED BY LAND SERVICES OFFICIAL: ' , DATE: /�/�� <br /> C g '__._51 <br /> _ i ./ice.. � a .r <br /> UPON APPROVAL: APPLICAN UST POST COPY OF a CS7? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r 41 m o <br /> t� Q <br /> Transcendent: Page 1 of 4 n 3 t' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 I' i, iffl <br />