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LAND USE PERMIT APPLICATION - Burnett County, WIi I. -. -o <br /> Applicant Complete All Sections Below This Line 3 <br /> a v <br /> Dwelling/Principal Structure $300/ Addition/Alteration to Dwelling/Principal Structure $200 .,Permit Types and Fees:(Please,check appropriate boxes <br /> d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v eb <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I r�� <br /> / Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e so <br /> l• <br /> Filling/Grading $150 Boathouse $500 1 g IA <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 l <br /> in , <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 as accessory structures,such as:pergolas,landscaping,etc. v k <br /> Property Owner's Name: t t 4A/E ,(_/'kc& -r —_-- z [. <br /> o <br /> Property Owner's Mailing Address:8/0 /2, .J epy razes 1.F' S / �C�- i✓c /r1N/.i G/b g <br /> City State Zip <br /> Property Site Address: Z9',57 1) ,✓ i1,ey 2q,r, De, .bit Ai:A . ty LA)i _' cA <br /> Contact's Telephone Number: 7/5 -- q 77- af-95 I ,i7o c G <br /> •�) a <br /> Contact's Email: J /t/i/..L -' �/ilQL,.&ppi 0 e <br /> 8 <br /> Legal Description of Property: SEE f7774gZ'h/1-D .r <br /> Section#: Town#: N Range#: W Town of: I *a <br /> *Attach additionalpage ifneeded or lengthy description OR attach a co ofthe deed OR attach taxsystem property page.** <br /> f 8 YPY P P tY P 8 p <br /> N <br /> a. <br /> Tax ID#(1-5 digit number;found on tax statement): -.z_93 / <br /> Proposed Use of Structure/Addition: 5' /2/fe£ cm <br /> H -1 <br /> Anticipated Start Date: 9- A., „c.7.1 (Home/Cabin;Commercial Business:Bedroom:Deck;etc.) f <br /> Building Contractor:...iePc"` Pete; �r1/DyrKsr�,wgr•Sewer Installer: ,d 4 -I ep <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: cA CA) <br /> **The applicant need.to contact their (DC Inspector to determine if a permit i needed from them prior to In V_ <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z -� <br /> home additions,and bunkhouses.** 7° <br /> isle 4 se-+ S. <br /> c - , hut/net/ 4.0AeCitC)/1 sly toxty) Nees d-t, nee- ckll 5e 4 <br /> .. <br /> i Fee Rec: 1 D <br /> Check#:1-- 6545 <br /> WI <br /> Date of staff site visit:1 /8 I2-I Initials if site visit staff: �� a CD <br /> z <br /> m r <br /> APPROVED BY l.ANI)SERVICES OFFICIAL: �� • ��DATE: ����t � < agill <br /> /� y cnco G vv <br /> UPON APPROVAL: APPLI . ' ST POST COPY OF r, 5 w <br /> gifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m 0 r„ <br /> ,e 10 w� N <br /> Transcendent: Page 1 of 4 cg <br /> m 3 <br /> ft Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 m Uuu� <br /> o t l Ji <br /> a <br /> 3 <br />