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• <br /> LLAND USE PERMIT APPLICATION—Burnett County, WI Applicant Complete All Sections Below This Line <br /> ri ermit Types and Fees:(Please,check appropriate boxes) CD <br /> V Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �� ''N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ,? <br /> Filling/Grading $150 Boathouse $500 '" �l? <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 qi <br /> .` <br /> r r <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = k <br /> *Communication Towers&Signs require a different application form;see corresponding application, and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> l/ r @. O <br /> Property Owner's Name: D/e4re. elorr��S(Mar/C) t�Y� Ilf� (IQ.L�-rz) ° .. <br /> 289 f0q' la-: y� Leda st-.iv ,�, ° <br /> Property Owner's Mailing Address: Hvd sth .t S01/ i*) 54Cjlo o <br /> �/) -5��(D ND it �` to Zip <br /> Property Site Address: gN93 QaiPi� 1 ,6,, Dr. s/rt°/)J 10 �- <br /> Contact's Telephone Number: ��L► � < <br /> p &/2 . 242•/4/&2 I k2 .9a9- o y <br /> Contact's Email:/ea/e. b/DL finer$e aktha s Pi I flpia ne i e g' i /cli • e .,,!, <br /> Legal Description of Property: Fa. 60 K / 5 f to (,e, 2 -2 E) `" <br /> N b % r <br /> Section#: Town#:_ N Range#: W Town of: = °q L1 <br /> ' <br /> *A ttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax 1D#(1-5 digit number;found on tax statement): 2'9 7 q <br /> Proposed Use of Structure/Addition: /n �/91,9 ...X.-3L4 <br /> Anticipated Start Date: Ma 20 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Q` '- x <br /> Building Contractor: Ere 1-1-ar/er) Sewer Installer: Wade. f tic=6/- )i, -) C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY `.p Gi GIw \[ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: pQ <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 (a <br /> home additions,and bunkhouses.** �^ <br /> D /hee-f-a(/ 5e c <br /> (9 UQIo1 44;h:7aviti '�� <br /> IIOP1d coif, e45 0c CVP- ,21- 1 <br /> � s Fee Rec:�,�I�C? <br /> 5 LMktila'e N C'4 d D l+ b p <br /> ti rooms per/ 54N 1 R•`°�o Check#: g <br /> o <br /> ( 01 <br /> Date of staff site visit: a /" / c2a- Initial of site visit staff: N" z <br /> / • ' 1 =:J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:S/II4a3 �- <br /> I EN <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> C <br /> N� <br /> Transcendent: - Page 1 of 4 .� w <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 1 NI <br /> J <br /> 3 <br />