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LAND USE PERMIT APPLICATION —Burnett County, WI cr <br /> : g <br /> sb <br /> Applicant Complete All Sections Below This Line o '4 t <br /> Permit Types and Fees:(Please,check appropriate boxes) e l <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 . <br /> V Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> /‘ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 oe 11:"-\ <br /> Filling/Grading $150 Boathouse $500 0t' 10 , <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 4, <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 <br /> Property Owner's Name: Thima5 et.nel Tina (14. Skedx --A,. .,, .o <br /> I <br /> Property Owner's Mailing Address: £a I I W s+ bib . 0iiiaLka4,Sa2 lu.ni. 55317 g <br /> �� City State Zip b <br /> Property Site Address: 3�1a- �S briVL.f t i.I tu' /ICILY) �`I <br /> r, 516155 E y <br /> 00 <br /> Contact's Telephone Number: y5o3-a2/0-7°69 (Tina 5 cep)Contact's Email: f`5heI 4i7'Icr/s/,Gb/Y) CD <br /> a..—c'! '7' <br /> d <br /> Legal Description of Property: Pkti- ©f-Litkt ,2&, ke.rJ Cold, UAi f^464- /h/ecce.S /rn <br /> Section#: Town#: O3 N Range#: W Town of: ,xrjss _ common � b <br /> a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> ff. <br /> Tax ID#(1-5 digit number;found on tax statement): ;.,2�2t h O <br /> �GioytQ. to " ,, Amain-fv- cpn ivut )U ifis cabin art- ty, <br /> Proposed Use of Structure/Addition: `VI,5Litt.U,td (1'd50 0610 i l-e cp hAll11O OAF <br /> .c�JJ p, <br /> Anticipated Start Date: D (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N o <br /> Building Contractor: Sewer Installer: CO <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 CP <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 bunkhouses:** 7 �3 <br /> 1 )iee4 a U 5e4 + <br /> 01 u tt0l d 41 i V+rR-a-?-o4 Coria•-fi'o4,5 1� <br /> z Fee Rec: /oti — <br /> c <br /> Check#: J/L// / <br /> rn <br /> Date of staff site visit: 76.3/?"). Initials of sih.te visit.t. . , a - <br /> / / z> _ <br /> ' <br /> v <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL: qii rt <br /> ' DATE: 5/28/?-a <br /> m <br /> UPON APPROVAL: APPLICANT ' UST POST COPY OF a g g <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z y <br /> Transcendent: Page 1 of 4 v q N Q <br /> Laserfische: Burnett County, WI Land Use Application -Rev 12/2020 m <br /> 0 <br /> vl <br />