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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line -g' ;N� <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> Dwelling/Principal Structure $300 'Addition/Alteration to Dwelling/Principal Structure $200 a wC) <br /> Commercial/Industrial Structure $ Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $159 Addition/Alteration to Accessory Structure $150 <br /> Accessory <br /> 9 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ` � <br /> I Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250Gn \ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .- , t <br /> I Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) ° <br /> p g $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. „ c' r <br /> ry 47--, <br /> Property Owner's Name: I kM M4-v\1tLL--k AM S ° z r-r <br /> e Aro r MN SS1Z3 <br /> Property Owner's Mailing Address: S O RECNiL€-A Di .Wt SOUT14 <br /> City State Zip <br /> Property Site Address: 7��5 F-6.0..-02.6Rump 1 mEe— 0� of i Tjy€ I �n <br /> Contact's Telephone Number: (o12---LA ) -- --7e o7. <br /> Contact's Email: 'tt M LZ <br /> , i.) e JM&; I, corn e <br /> J c <br /> Legal Description of Property: Vl�"(' Ol lt-F LP of NLS S'j-4,,A¢ie(Z <br /> N <br /> Section#: 1?). Town#: 39 N Range#: (L, W Town of: MEAN Qr�1 . °4 <br /> *Attach additional page if neededfor•lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 1 i SSS <br /> i <br /> Proposed Use of Structure/Addition: "TOOL EQ),PM�tvT 5i-�£tDcn <br /> Anticipated Start Date: 1-z-/-2.--z_ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o X <br /> Building Contractor: gict4 S eL. CAPQop- Sewer Installer: 410. <br /> H ' <br /> .� I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> —...2 i 1.,.....0 <br /> **The applicant needs to contact their( DC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place fttr any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions.and/ bunkhouses.** / /1 ,1__� x O <br /> d/VO 1W be use./- e* Ail wA cr a R_ .S , \!J <br /> 4 �w,e. pe�^�idKs ob ie-- d 1" 07 cfv,& mef 20-et <br /> o'F Gle-a H e,el 1,4.91 vi) j 1-14 r S !q c_e_.(2$' 7v 6e. mSot oe <br /> by 11/1/zo zz.-. Fee Rec: `SSW <br /> 0 <br /> • Check#: f7 h <br /> [y n r <br /> Date of staff site visit: -I 1/ZD 2-2— Initials of site visit staff: yr i // <br /> / z <br /> C <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: / <br /> DATE: 9 �� Z I <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF a l W a <br /> c Cs <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Ti a <br /> (Afi <br /> Transcendent: - Page 1 of 4 • w <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 • § �; c: i <br /> °' � UuIJ^ <br />