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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c titAj <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> LI, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Q` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure CaO) cls. 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 <br /> ; <br /> 0 C. <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 I\ <br /> v) <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 bet treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: Sieve eV e/Loft, KO Ae 4,Z., z <br /> 0 <br /> 1� <br /> Property Owner's Mailing Address: 31 ( z <br /> 40 A.v 6 $ r►" ``vt�espea S Avo 55 4o6 g � <br /> _ City State Zip <br /> Property Site Address: 1 to 4 1 -11 f'A tta bt)_‘` 't 1).4.%4_ ,,vZy u.,:t 52V5i n <br /> Contact's Telephone Number: e)e_b4 k.) ��e ;SB� o N C <br /> Contact's Email: b rq, d• .t- e �r -a,k1 , g o1oc1 t # Cb 41• d ,_ <br /> CD <br /> Legal Description of Property: S\ 11 / I 1.0/ I< I S i-tJ- ' `I M8 t9 r+. D I)1 t) 01,407-15"--IJ L' -1 <br /> J At-ITS42Vl0 c <br /> Section#: f 1 Town#: <br /> 5 41-0 N Range#: 1 IS W Town of: / =. <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> 9 _ <br /> Tax ID#(1-5 digit number; found on tax statement): O'� <br /> Proposed Use of Structure/Addition: STB A-S „, y H <br /> Anticipated Start Date: *.,J [d��{ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C+ o _ <br /> F <br /> Building Contractor: -PPe i& t b A $ [' Sewer Installer: 10121 y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a —� <br /> & <br /> --C)**The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z 9 <br /> home additions,and bunkhouses.** <br /> ifiYleee-- cal 5e-iktk,00 5 <br /> e ilia I-, ( kto4^4*1 b,f-a4\%6 T) <br /> 54ej Oil lv4- -la notrtcr�s lqA, V$e t4 ., 5Fee Rec: �[ ei ✓( 5T <br /> o Check#:/O <br /> Date of staff site visit: 6l l( ?; Initials of ite visit (/" z <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: 00#d% DATE: .4/6.3/1;p` n a 3 <br /> UPON APPROVAL: APPLICAN ' UST POST COPY OF "3 <br /> M 13. <br /> C <br /> > 6 m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z cn <br /> ; <br />