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. LAND USE PERMIT APPLICATION — Burnett County, WI a P. b <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Kt Addition/Alteration to Accessory Structure Z .$3Se- O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CU <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. 51 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. co <br /> o g <br /> Property Owner's Name: 1 i r�N.\ ``��� ,�C`�1 'r i (' y\q, r i o <br /> Property Owner's Mailing Address: I� �vC-1 b 5 1C'aj L a.° C+- -kl'MQ,ifl \1 5''�'C036_ o <br /> 1 y �� City State Zip i <br /> Property Site Address: L}Soy o r•v i no c- e r b rNI tNb o r.J ,VJ'I 5 g 3 0 ' cA <br /> Contact's Telephone Number: 0 g- 3 q" l Q i q < <br /> Contact's Email: + fr%Or €. TY)So CO rrN Lai / 5"751/' I/O/a 9 p J-7:5 y t7 <br /> i w <br /> Legal Description ofProperty�ot Qidc' (L MA \)O'Acx Vie'( ' I\ 9. Lot 1 g N ro .. <br /> Section#: I S Town#: L{() N Range#: i S W Town of: ,jpc_ so Y' S °C <br /> 5, <br /> *Attach additional page i neededfor lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * a` <br /> Pg .f S Y P Y P P tl'P S p <br /> Tax ID#(1-5 digit number; found on tax statement): R �`e� 0' <br /> Proposed Use of Structure/Addition: Lt'_i.in - -I� a r, Gs' i eAgue_ N Or"+tI) t t 'j ` ) <br /> Anticipated Start Date: (Home/Cabin;CommerciXBusiness;Bedroom;Deck;etc.) C., r o x <br /> CD �\ o C7 <br /> Building Contractor:Lz i k - I l rc ' Q:he_ Sewer Installer: — <br /> _, W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C)\ <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 Z <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z R cc,N <br /> home additions,and bunkhouses.** I ] <br /> i y41et aiII Se .I <br /> ,vc w,kri h a ,� v" �, <br /> i <br /> LDS- 1,ri-e5 citt d 5h%4cAlkie 3V4 evitef Seci-b.,,Ls , 5 V e_?1- II? x Fee Rec: 01�J� <br /> K. Check#: i'a,�'7 <br /> Date of staff site visit: 7/'2 6:)l oZ' Initials i f site visit s ff: , L r- <br /> • <br /> APPROVED BY LAND SERVICES OFFICIAL:, DATE: 1 OV/? <br /> UPON APPROVAL: APPLICAN UST POST COPY OF ..F <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ; o fill <br /> c <br /> Transcendent: Page 1 of 4 s, ra <br /> Burnett County, WI Land Use Application—Rev 12/2020 ` <br /> Laserfische: jlf(] <br /> o <br /> -o <br />