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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> Applicant Complete All Sections Below This Line c o <br /> Permit Types and Fees:(Please,check appropriate boxes) °- c <br /> 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 '` O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 .0 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 \` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 r Lam. <br /> o • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0. <br /> —1— qE ti <br /> p <br /> Property Owner's Name: / 1 PA i T ,ii RII2 51©4-19 o <br /> Property Owner's Mailing Address: _ i e A, Q , . _ / .� <br /> nn .` City / State Zip $ <br /> j Property Site Address: C7 '5 ,(�5 j , 4,42p !'14Ke DK /fleb e/1 l�„��0325 F. � <br /> W' <br /> Contact's Telephone Number: 7`_ "'. (o—0'7S 9 0• F ki� <br /> CD <br /> Contact's Email:2Len W/�� oil A J-TQ) Ai J , £O?— o \\ <br /> Legal Description of Property: 1-..,71- e• GS114 V 2.7 4 3 7 .2. r <br /> 2 c as R <br /> Section#: 32- Town#: 3C1 N Range#: AS W Town of:5,9","0L11 3 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> :63- <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: 2g "' <br /> H <br /> Anticipated Start Date: (Home/Cabin;Commercial Business(Bedroom;Deck;etc.) 0 X <br /> Building Contractor: 'O L/¢ r/ i/'v Sewer Installer: t/� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 I <br /> IN <br /> -LVF construction taking place for any dwellings, dwelling additions, manufactured homes,manufactured z ) <br /> home additions, and bunkhouses.** <br /> -- y fv v low/day / he—/H q d /- 4,..cinsm <br /> 7/0 <br /> 5g744 7e- v Ue5//col/c4'4d,1 /41 GU/n-/ -07 777 <br /> file. (lt�W) S4 47e. 4e, sc... vt 6!M 4e r`pc?c' 7`f l s /VP— <br /> _ <br /> /O 6977®til 1,0/// eg w/�� � S e_eml�. Fee Rec: <br /> / LL <br /> �. � ✓ CC Check#:/l/ / <br /> Date of staff site visit. Initials of site visit staff: miv z <br /> o <br /> n <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/8 7U 240 < <br /> n <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF CO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° 3 <br /> 2 E.W <br /> W <br /> �o w <br /> Transcendent: Page 1 of 4 n o <br /> Burnett County, WI Land Use Application— Rev 6/2020 < a <br /> Laserfische: < 3 <br /> a <br /> K J <br />