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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line O t W <br /> Permit Types and Fees:(Please,check appropriate boxes) % <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> K Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> r 9 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 OD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 '' . 4 <br /> C� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r• <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> elk <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. n <br /> Property Owner's Name: �eM0 r "S., M�cc�c�t lc \c7 z <br /> l+ <br /> Property Owner's Mailing Address: I C\ (O E-Oec'cc e�m �-c no W oAlLaim /"\l.1 55 t"Z S g N % <br /> City ) State Zip ib <br /> Property Site Address: 41 O 4 M'A i 10C d L-04C-Z C' O c c\ 0. <br /> Contact's Telephone Number: (QS I - 34 3- 0'4(o I o y nQ <br /> a <br /> Contact's Email: rY C 4 .cc C Cs`c`c�C ctS�' Y\-E� vv d <br /> Legal Description of Property: Lo 4 2. Oc- (-S l"l U-Ceic1 VCI—3 PG.50 trcccy.444 +•(1 ( pct. LOT.$ <br /> N b <br /> Section#: 3 S- Town#: 4 U N Range#: (5 W Town of: 10.c..k ScrC\ 0 ao <br /> *Attach additional page ifneeded for lengthy description OR attach a copyofthe deed OR attach tax system properly page.** °4 <br /> P S gY P Y P P h'P S t7 W <br /> Tax ID#(1-5 digit number;found on tax statement): C2 0 2.4 I. <br /> Proposed Use of Structure/Addition: i.k u w �.�c4 C ' �ccA,c, fr ; s�1� ,, <br /> Anticipated Start Date: ?j2 t I ZOl3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C��1 c <br /> '�o 1�circ eC' Ili.C- t}1 t7 <br /> Building Contractor: d �r S:�bccr c, Cs Sewer Installer: p -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N-) <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 <br /> home additions,and bunkhouses.** m <br /> -4- �- St-►-ems L. <br /> a N' r{ - k \ LLiO 1° <br /> NN Y�/ �� Y� (����! ` 11r� by /2 `*3 Fee Rec: 7 <br /> ` m � Check#: /3- <br /> /2013 <br /> ff <br /> r. <br /> Date of sta site visit: IInitials of site visit taff: a <br /> APPROVED BY LAND SERVICES OFFICIALL VA.A1 Y DATE: U 1!l(G/ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <` 0 <br /> 4 � = <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT x o N <br /> �v <br /> . N.) <br /> O <br /> Transcendent: - Page 1 of 4 A w <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < 3 Eill <br /> v <br /> i <br />