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LAND USE PERMIT APPLICATION- Burnett County, WI `° to-. b <br /> Applicant Complete All Sections Below This Line ° 6 <br /> Permit Types and Fees:(Please,check appropriate boxes) Z <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> co <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 � �O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 t-- k.. <br /> a <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ' <br /> c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: L rQ A . or l o n l_ L . Nelson T I, <br /> Property Owner's Mailing Address: 81(05 (? ( \i W` L, . 61 .1(., e LI 5.1211i <br /> �, r Q, j "� I City State Zip b <br /> Property Site Address:c 9 /1(, `V J. ULl 7CI ( L< . 11d , . <br /> Contact's Telephone Number: 1 15 1-6$ oS 3 a 5 Or -1 1 J - 56lp-4(oO 5 `� o r t <br /> Contact's Email:W t , Y'i�� ZO 3 • ) Ckhco .Co }'Y' d <br /> CD <br /> Legal Description of Property: -PC L. N 5 Val D e S -d 4 3 7 7 4 7 <br /> N <br /> Section#: 8 Town#: 3 R N Range#: l 4 W Town of: De(me Y 18• °Q <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach taxsystem property page 't <br /> ri <br /> .* <br /> �' <br /> P g f f b' Y P P PQS <br /> Tax ID#(1-5 digit number; found on tax statement): al a(p 3 <br /> Proposed Use of Structure/Addition: r `s j �c n c <br /> Anticipated Start Date:5 f CI • ti 1�� (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) o <br /> s <br /> ,� 1 E <br /> Building Contractor: U (i L Q f AQm e,.Cj Sewer Installer: A 1 i-e a,d i i n9Q)1 e.d <br /> �J .J H 1;:, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: "Y <br /> **The applicant steeds to contact their UDC Inspector to determine if a permit is needed front them prior to N <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> ome additions,and bunkhouses.**** <br /> l Cv1,4:L/- IAiL ZASi)e-c--OH 7lb e9i74/H QlAy 10fr l'�S /j-et. W <br /> /� 12I1t ► eyalpv___, <br /> 1 )1 No f fo -e-XGe e� 3 6 �tro o/"1 S Per' S, /U- 3( 30 <br /> . -q 1 l�le-$/� /be- gf's,es�d m� p-e-r S k uire.t'"tP�✓l/se 14 Fee Rec:3O()-� <br /> a O W Pam' 4 Aq i.e- 1 t5 etfe. cj4 u e l/h en 7� e- 4 0 Check#: �V 2 <br /> y c- <br /> Date of Staff site visit: /eV/ ZO Z`Z Initials of site visit staff: ,T /'�i T z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ��0�Z Z < w - �rr <br /> 71 <br /> a. <br /> Uul <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF aG.W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y ....*-1 <br /> -< oc N. c <br /> Transcendent: - Page 1 of 4 w <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 m 7 flfl <br /> - <br />