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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> < <br /> Applicant Complete All Sections Below This Line o c <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 )I Addition/Alteration to Dwelling/Principal Structure $200 d 43 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Lo <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N.. 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 11 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> C') k) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° 10Filling/Grading $150 Boathouse $500 r Y <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o <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 fas accesso—rystructures,such as:pergolas,landscaping,etc. b <br /> Property Owner's Name: nhcJly —1- 414rty l�knt °4 z <br /> U I o <br /> Property Owner's Mailing Address: /y5Y /� 5-1034 )t t.s (►1 SIM z.4 o <br /> City State Zip $ 1=J <br /> Z3fl8 � <br /> Property Site Address: � w n ISN <br /> Contact's Telephone Number: 6 (L (o l- 0175 o N <br /> Contact's Email: (4)C 1N f,-si-Gn.5.n(b Ke--ev.co", <br /> a <br /> Legal Description of Property: 60,A- 1-4 S ,p k <br /> Section#: S 20/ Town#: 3 7 N Range#: 1 fj W Town of: 1'c( �Kt o w Z1 M <br /> 5• 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> 4 <br /> Tax ID#(1-5 digit number; found on tax statement): 2S I S/ F <br /> Proposed Use of Structure/Addition: /41w /"9'14/ kiL <br /> Anticipated Start Date: Aty La 2-"Z.... (Home/Cabin;Commercial Business;_Bedroom;Deck;etc.) o <br /> CI <br /> Ww �oJf <br /> Building Contractor: -the. t,,j Sewer Installer: <br /> CP H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDIT NS ONLY rlv ,t.. <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 c <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> Ilk <br /> home additions,and bunkhouses.** :h <br /> n pwe Il,ni AO+ -}v eicc ed L/ b " 's 5 pee -IV -I1L16? <br /> /hee-�- A (I e-f-b&c&5 , <br /> tit LOG # Cha;A (5 heeded ©n Seffic 4aoks l to /1/?? <br /> Fee Rec:�d� <br /> 5 <br /> Check#: <br /> I' a <br /> Date of staff site visit: 7117/?-'67 Initials of s' e visit staff: T L <br /> 1. �� aa <br /> APPROVED BY LAND SERVICES OFFICIAL: ,� /�, DATE: 7//A1a02 < �C7� <br /> UPON APPROVAL: APPLICANT ST POST COPY OF a afil <br /> Rii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a"xi CP co <br /> cD m r <br /> -C N A 00 <br /> Transcendent: - Page 1 of 4 py m c <br /> cC <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < la-< <br /> a m git <br /> A <br /> L.L. J <br />