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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> - b <br /> v, N <br /> Applicant Complete All Sections Below This Line 5' n o <br /> Permit Types and Fees:(Please,check appropriate boxes) .. <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c <br /> ` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,J <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 1V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 o <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. E. <br /> i, <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. l <br /> I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 0` J en LtVi(‘A I(Uh Xatb. °.I1L 1D 0..eli40?:otiM t o r ' <br /> Property Owner's Mailing Address: a`r-1`T 7 Lo tti\ Cl Posjr\ 1 ) I °Li <br /> o Oil, <br /> a�`(7(r? CR- City State Zip ---. <br /> Property Site Address: T 400 ,W i 3(180I E' <br /> Contact's Telephone Number: `OO8-6(40`VP°6 C QtUC.e 4310(vt o 7 <br /> fi <br /> Contact's Email: r.---&)‘.1M�U Ma, 90AaL`.ColnnnpQ40/09(23 <br /> a <br /> Legal Description of Property: L0+a c5m4I a�I V& P L I (6TOV t I'a) 4o2O9 37(6-1Ws b"16 <br /> -� a as <br /> Section#: 3LP Town#: O N Range#: /14 W Town of: SCOtt 0. <br /> oce <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.** <br /> Ci <br /> Tax ID#(1-5 digit number;found on tax statement): 1 aa9 3 g <br /> Proposed Use of Structure/Addition: .5A-0{(9 ea <br /> o —3 <br /> Anticipated Start Date: -!-c 0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 <br /> s <br /> Building Contractor: e-\'C nSewer Installer: NIR u <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 t Ni <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured 1 2 <br /> home additions,and bunkhouses.** x' <br /> Not Fj r �.uw\b-v` ��C\& 0►'� <br /> Fee Rec: /5-05) <br /> 4 Check#:_,_,, z <br /> -. .),i 5 ...---D bdz <br /> (kArri <br /> Date of staff site visit( itials of site visit staff: a <br /> 1 • <br /> of <br /> APPROVED BY LAND SERVICES OFFICI DATE-716 �� - _______115 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Cr)W <br /> Ril <br /> SIGNED PERMIT APPLICATION\IN PLAIN SIGHT w <br /> CD C 0 <br /> Transcendent: - Page 1 of 4 0 o Q <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 6/2020 '3 Pi] <br /> JJ <br />