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LAND USE PERMIT APPLICATION — Burnett County, WI 6 <br /> a <br /> Applicant Complete All Sections Below This Line '• <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ",z <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> AccessoryStructure Commercial Industriala <br /> (Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse $150 m <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o p� \ <br /> Filling/Grading $150 Boathouse $500 r I}"7 <br /> Six Month Cam One Per Year ° <br /> in <br /> p g Unit( ) $100 Permit Extension(1 Year Extension Allowed Once) $100 <br /> 1 <br /> cn <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. w <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> I ` r- g. <br /> Property Owner's Name: PA I LLct-tl ai . 6(l b 4 z , <br /> o c <br /> Property Owner's Mailing Address: I -1-q!' t'"(ii1 1 til lS &' (....„e,„,(11( 4)A,/ 5) W( o <br /> City State Zip <br /> Property Site Address: Z C p\& �' dk. 161.b ii() kJ 5-1-(q 3rd a n <br /> 'I (l5 <br /> Contact's Telephone Number: i1' .-3 To -��Gcq o ,,, <br /> • 0 <br /> ' IContact's Email: Yh -NQt �i�� , tOti .i. , <br /> � <br /> CD <br /> Legal Description of Property: SL- 'A il <C VI <br /> 4N ao <br /> Section#: Town#: I( N Range#: I C W Town of: 5 jul I f S <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): ) ) ,<jt. 8. <br /> Proposed Use of Structure/Addition: '&-(L.v.. <br /> Anticipated Start Date: Q, 147 1,)1.z- (Home Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: i<t4 i� i'w►^5 i et.C1-#1t;ice-S(-it,( Sewer Installer: .- <br /> vs <br /> ,,,„ <br /> d <br /> _, , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> VI <br /> **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 0+ <br /> home additions,and bunkhouses.** x <br /> (10/ee-c- All 5 <br /> 0 NDA 6 k44k ka b. �� <br /> 0 pr;ve WC' b4C -f v 3Ala e flt'`+ (4ee4 �o 41- ckAreal-e. <br /> r um tie m x Fee Rec: /601?-3 <br /> 4 Check#: .7'L55 <br /> // 8 <br /> Date of staff site visit:7 ` <br /> 1 i 1 Q /7? rl` <br /> Initials of site visit staff: 'J z <br /> d . <br /> cA <br /> ri <br /> APPROVED BY LAND SERVICES OFFICIAL: /2 1la <br /> Fi Q . <br /> .. . u uu <br /> UPON APPROVAL: APPLICAN MUSDATE• !T POST COPY OF 4 r- <br /> :='''', © <br /> I _w <br /> iiiip <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z o0 0 <br /> E o Q <br /> Transcendent: - Page 1 of 4I N <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 r' a Ira <br />