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• LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> b <br /> N . N <br /> Applicant Complete All Sections Below This Line $ t. <br /> Permit Types and Fees:(Please,check appropriate boxes) -- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V.J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C) Pr <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ` °<_ / <br /> Filling/Grading $150 Boathouse $500 0 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 P <br /> C/' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. P \ <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: /i i d f-Il) t L fi 5. / h 6,'4-/Z 31/6..-- 5”11... z , <br /> 0 <br /> Property Owner's Mailing Address: c 2 .. / L. 5 6/4 A L - <br /> J (Z DR- o �, <br /> o <br /> M ; e- CLL/OD l), 1 5V // (?YState Zip a <br /> Property Site Address: "?.rGF'y / 4 6QE..?N /A. LcJr'R5 /Z- . cn <br /> Contact's Telephone Number: L fJ 11(L 7),-. 144tZ) / S 3 3- 00 'z ° z <br /> Contact's Email: �,ci(c/L. ) (L t Utc (Z5 —4/0fZ-(C7 , 0 d <br /> cp <br /> Legal Description of Property: 4> , ilef/eC1 <br /> °o <br /> Section#: Town#: N Range#: W Town of: <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): / 4' ? '7' <br /> cn <br /> Proposed Use of Structure/Ad do i .3 -� <br /> Anticipated Start Date: 7// 2.e.'7_c.7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> A / <br /> Building Contractor:e64flk �e.Q-�/�Sff/9cv Sewer Installer: f.4,./74?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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> id Note of -Arse sA uchAr 01.1- Ioc used Oar km' fO 11"aI• d <br /> 4'6601 aU Mood lain CoudikoP s/nrpt rcwtewfs, <br /> P <br /> � /Mitt leS riw.u6t MU* 10r Siege At 1 Mes. Fee Rec: ©� tT <br /> `,� <br /> o <br /> F" 4 Check#: 363 <br /> / r I sad Ace 5,or, <br /> Date of staff site visit: (//2q/�� Initials of site visit staff: z etc ttit/^L f <br /> APPROVED BY LAND SERVICES OFFICIAL ATE: 0/2.02.0 < < J <br /> Irgll <br /> UPON APPROVAL: APPLICAN UST POST COPY OF a;, c <br /> iar � z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1-,,,, <br /> ruIol <br /> C N <br /> Transcendent: Page 1 of 4 co <br /> Laserfische• Burnett County, WI Land Use Application—Rev 6/2020 3 o PO <br /> ] LJ,- <br />