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• LAND USE PERMIT APPLICATION — Burnett County, WI <br /> - Applicant Complete All Sections Below This Line 6' o <br /> Permit Types and Fees:(Please,check appropriate boxes) i !IIk.)-) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?; w <br /> o ` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 vim, <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N O <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 .- ,,. <br /> ck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <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 w <br /> En ilk <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t <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: M 1 c ha e-I Hagen z p <br /> Property Owner's Mailing Address: U1 9j *L(1 'j t (I aCI (Vii ? I G <br /> P . State Zip -0 <br /> Property Site Address: PN(A7 �f i �r ' 0 / // ;.' n <br /> Contact's Telephone Number: 6512i-1 fil - sco "". o N <br /> co <br /> n <br /> Contact's Email: 1 OYC CoCo0.2 j 1'n f . ( 0 Y"l 0 d <br /> F <br /> Legal Description of Property: Sec. i3 L 140 Lf1 (SM►kig5b V to r32 (GcvL4rt3)#2VI j7l, .. <br /> N `o <br /> Section#: %3". Town#: 4t) N Range#: ( '7 W Town of: u// /o- _ °° <br /> oc <br /> *Attach additional page if needed for lengthydescription OR attach a copyofthe deed OR attach tcc system roperty pae.* <br /> d <br /> Tax ID#(1-5 digit number; found on tax statement): 1 77/ T' <br /> Proposed Use of Structure/Addition: / `A <br /> �/ / 0 P <br /> Anticipated Start Date: `"7 <br /> J _ / r 7(aZtJ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E x <br /> = C7 <br /> Building Contractor: it/' Sewer Installer: /VA <br /> -i !-, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERIVIIT 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 <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes, manufactured z •--. <br /> home additions,and bunkhouses.** 7' <br /> e b r ve_wal. mus--1--- /Jot e-1-- ally i Ilo Ser <br /> --)—{1611,1 ,--7 5 Ft ,prc ryk cx- rt q / ' /i A t r ma l< <br /> • V i�w Corridord �� �W / � �� = Fee Rec: 1��— <br /> /� 5U 163 <br /> c <br /> Check#. 7 <br /> . RDate of staff site visit: L%7 `�" Initials of site visit staff: D <br /> z <br /> APPROVED BY LAND SERVICES OFFICI DATE: ,.....K....d6 < <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a co `_ <br /> z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 6 <br /> 0 <br /> me tv <br /> Transcendent: - Page 1 of 4IS AI.a < <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 ' g C' TN <br /> L <br />