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LAND USE PERMIT APPLICATION-Burnett County, WI f r <br /> NN <br /> Applicant Complete All Sections Below This Line ° CD I <br /> ► N <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 KN <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 o ti D <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 kj <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. $ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. co <br /> �r.Yrhi H. o g. <br /> Property Owner's Name: E{�lSt�'YI o <br /> Property Owner's Mailing Address: po TJX tlO/4 We r C V V/ 5z/433 F. <br /> Cit State Zi 75 , <br /> Property Site Address: ?I One- (Oa:/ace/7i' 53/0 <br /> City Road 35- E. nn <br /> ci i <br /> 715. 377-2-5� < <br /> Contact's Telephone Number: o <br /> .---_ a <br /> Contact's Email: ' $/4iiiir••1!I ,Latif .'_e. .I,•• i E.1 y• ... C� e <br /> Legal Description of Property: Z.014 5— C 5J',/ 1J0�.f 01 I q, 7/ <br /> / <br /> o 0 <br /> 5 <br /> Section#: .018 /Town#: 33 N Range#: /Co W Town of: Me/J-107-1 ' 0 <br /> ao <br /> *Attach additional page if needed for len thv description OR attach a copyof the deed OR attach tax system property page.** <br /> C. <br /> r <br /> Tax ID#(1-5 digit number;found on tax statement): 379- <br /> s7 P2 3a t , <c'teu; s gimp 2) <br /> Proposed Use of Structure/Addition: , ,.- -] <br /> Anticipated Start Date: l°Xi'Sf//19 (Home/Cabin;Commercial Business;Bedroom:Deck;eYc.) oN0 x <br /> d <br /> Building Contractor: Sewer Installer: 4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from tltent prior to a, <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z ,---„Rhome additions,and bunkhouses. <br /> 0 7115 I, 4 // /S �v✓' 14C- / 3 card c.0A740i H PA^� 1 w <br /> � <br /> as $ h GCM�m.^�. <br /> Ltota.� u �Z/—/g �' <br /> © two//m PO ce# c e ‘44,4,4;lAs a S /1 s /4 cup- z/' <br /> lg-. 00 <br /> �� a /� z Fee Rec:kG� <br /> flits0 /s ah c I ei -' Ae.---rqd pl�'.!''iA /,/, o Check#: /!5/$ <br /> Date of staff site visit: Initials of site visit staff: ;ill'''. <br /> z <br /> Ia <br /> APPROVED BY LAND SERVICES OFFICIAL: s,000.— SATE: 0,70473: J <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF i ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a) 0 <br /> ITOTranscendent: - Page 1 of 4 n co <br /> Burnett County,WI Land Use Application—Rev 12/2020 1 ti, <br /> Laserfische: - o 2 <br /> I rn <br />