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<br /> LAND USE PERMIT APPLICATION- Burnett Countv, WI
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<br /> Applicant Complete Al) Sections Below This Line
<br /> Permit Types and Fees:(Please,check appropriate boxes)
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1-. W S.;
<br /> x Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200
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<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i ; ic...---
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I t.)
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
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<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i 0 1 9)
<br /> Filling/Grading $150 Boathouse $500 I 7 r-- .r
<br /> Six Month Camping Unit(One Per Year) $100 !Permit Extension(1Year Extension-Allowed Once) $100 I —
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<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee.
<br /> Communication Towers Towers&Signs require a different application form;see corresponding application,and fees. $ t
<br /> *Items not listed above will be treated as accessory structures,such as:pegolas,landscaping,etc. 'F-
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<br /> Property Owner's Name: leenr1T-441 H Etick.,blei ri r fa-45M 'in j j loaf L .
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<br /> Property Owner's Mailing Ad ss: rel5 Old 3‹ Nely,ify WI co7-
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<br /> Property Site Address: i
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<br /> Contact's Telephone Number: 115'.31.7-.9f61, ,
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<br /> Contact's Email: 5 _..!..1A2114- 1 -•• ....... ,-. i C'
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<br /> Legal Description of Property: 1.04' 1 C11.4 V ILI P IC33 ( NW Nf)
<br /> Section#:_ get Town 4: 1.0_...._N Range 4: 15 W Town of:
<br /> *Attach additional page if tteeeledPr lengthy description OR attach a copy of the deed OR attach tax system property page.* 7.; ...... ! !
<br /> ....0 B Tax ID 4(1-5 digit number;found on tax statement):
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<br /> Proposed Use of Structure/Addition: p11141 41rirar,, 1 •
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<br /> Anticipated Start Date: 11, 1- 2. (H &Cabin;Commercial Business;Bedroom,Deck etc.)
<br /> Building Contractor: sei-c- Sewer Installer: 84/41
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ' 1
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1\)
<br /> The applicant needs to contact their UDC Inspector to determine if a permit A needed from them prior to
<br /> tIA)'construction raking place Pr any dwellings,dwelling additions,manufactured homes,manufactufey z Vki\,1
<br /> Itlrotne additions,afd bunkhouses." ,,, (::::) eV!yee DA M p eorlIvlitS x to
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<br /> Date of staff site visit: / // /19 -ea initials of site visit staff:
<br /> I • 4 Check 4:MRCS
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<br /> APPROVED BY LAND SERVICES OFFICIAL: TE: g 5.711
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<br /> UPON APPROVAL: AP 1CANT MUST POST COPY OF : W '3 kw./
<br /> 0 ie SIGNED PERMIT APPLICATION IN PLAIN SIGHT .
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<br /> Transcendent: - Page 1 of 4
<br /> Laserfische Burnett County,WI Land Use Application-Rev 12/2020
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