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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line °' <br /> CD 1 41.3 <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure 1$200 A w <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 k\ <br /> 7 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> •Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e ` <br /> Filling/Grading $150 Boathouse $500 r ; t t '4 p [` <br /> ( 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 f <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,itrsuch as:pergolas,landscaping,etc. <br /> Property Owner's Name: � yMij _ c, z <br /> 1' elt". I iA ' <br /> Property Owner's Mailing Address: 13 I� S. b I��h0Nt) (�g �-e1 C W� ( � S�� ° <br /> 0 <br /> !City State Zip - i <br /> Property Site Address:Litlici5 `J Yi'l i N(� SC;yti► —RA lt.�h�.i t 1"'? I.1�31 � # ii j .5-146 3O ° <br /> Contact's Telephone Number: @/� C?? <br /> -,i1 <br /> 'J elS <br /> "�� 0. <br /> Contact's Email: Kj °trQ M(Ul l p`(0 vi o <br /> J <br /> co <br /> r <br /> Legal Description of Property: S =•T I I N16,- 5u/L) Aso(T1p/1 AT (i( . ' I/046e.. <br /> Section#: Town#: N Range#: W Town of: ocK 561 _ °° <br /> go <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number; found on tax statement): a;'72. rn <br /> Proposed Use of Structure/Addition: 5 6 - !2 f‘,t O 'P l I"C `n <br /> Anticipated Start Date: 5r/( }"z 2_ (Home/Cabin;Commercial Business Bedroom;Deck;etc.) <br /> G y - <br /> Building Contractor:A 40 7 <br /> c" + 'jk- <br /> � ,y-r,24\e-ov\ > eSenwer Installer Nl <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY —� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ,..-i "••4 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 9 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses <br /> ipYe - c.1( G <br /> 0Nei- ( tiwmah hg AI `�" <br /> - <br /> x Fee Rec: " <br /> / / o Check#:3 O lc <br /> Date of staff site visit:5/ 049- Initials of 'te visit .t• %• D <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: P DATE: 6j/a-1?G) x r <br /> u, a M Yui <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a (0, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 a w <br /> Transcendent: Page 1 of 4 m . N <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 g +jrjj <br /> o <br /> a <br />