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rm <br /> c, b <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5 <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> 1\1 t <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d 'V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..,..%,/, �.1 <br /> " 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 /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° b 11. <br /> Filling/Grading $150 Boathouse $500 t--: b <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. o <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. \ <br /> *Items not listed above will be treated as accessory structuress,,such as:pergolas,landscaping,etc. �v <br /> Property Owner's Name: Rec�y 4 .4) <br /> fian9 Cl4r: -YtSca Al ° z <br /> �t o <br /> Property Owner's Mailing Address: 1 y6 K 13 6� J r 54 CroX iRs1.)r 3 • o <br /> City State Zip <br /> Property Site Address: /2-30f Cow Z <br /> Contact's Telephone Number: 61 L 8'01 - 0l-75 o FM <br /> Contact's Email: r?G11 C:s jt'it:.soN6 Ig--rpt".co-*, d M <br /> Legal Description of Property: Gy J4- 1-0.+ 5 . C <br /> . <br /> N b <br /> Section#: SZQ Town#: 37W' N Range#: fee W Town of: 17.h L4•C •- 0 °° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> R <br /> Tax ID#(1-5 digit number;found on tax statement): Zy IS/ <br /> Proposed Use of Structure/Addition: 5c..i'c j t.- ioft.t'S4b/stle� "' <br /> Anticipated Start Date: A.55t41 20_'2- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) F <br /> .t <br /> Building Contractor: 5c krbOf La./r Sewer Installer: f' ie ^` t7 <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouse .** Po <br /> d ,4 e4 al( 5e-f . <br /> dNom-- -66 Lota 6.- �c)/\0 mu meet w se.-fbactts -ft) We-1(44471arV <br /> Fee Rec: 052 <br /> Check#: <br /> a <br /> m <br /> Date of staff site visit: 7/1 as Initial of site t . z <br /> APPROVED BY LAND SERVICES OFFICIAL: / , DATE:8(5(a'a <br /> m io <br /> ha <br /> UPON APPROVAL: APPLICA MUST POST COPY OF - Q <br /> 0. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` a <br /> r OS ER <br /> , vo <br /> Transcendent: Page 1 of 4 nik 3 oN �' <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 3 L` <br />