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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> • Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Please,check appropriate boxes '" <br /> s <br /> -Dwelling/Principal Structure $.ri ?%. d.�ion/Alt anon to Dwel al Structure . 200 d <br /> -Commercial/Industrial Structure s. <br /> $ �J�A.diti.n Alter • n ustrial Structure $200 II <br /> V <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G] <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 1 o G SP <br /> Filling/Grading $150 Boathouse $500 rr <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. = <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 /> Ch <br /> Property Owner's Name: .1 e>b. V1 , 12-1 -t-. (.4.. --(1,9--y5-,,,v, -1 t— t <br /> Property Owner's Mailing Address: 3& D e> 3 ed4g- 7` �v / Ale- <br /> G '3I8 , <br /> 0 <br /> City <br /> �Q�!J.6-- R4S / -& �f14 Stat r Zip <br /> PropertySite Address: Gff`� � E. rn„ <br /> fid ` /748 - -77ZJ <br /> Contact's Telephone Number: �- �` I� o � ri <br /> 4, <br /> Contact's Email: e_y1 t t S 199 /a y .5&.) f�S I , <br /> Legal Description of Property:.Z0 � /9 SS/44' ,c fres S/6'7"'r/ 4/.5a) <br /> N <br /> Section#: `,) Town#: 1jl/ N Range#: /5---W Town of: S 40,..s.5 . °' <br /> 5. <br /> 7' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property age.* <br /> C). <br /> Tax ID#(1-5 digit number;found on tax statement): t: Q-6-3-7 <br /> Proposed Use of Structure/Addition: C44 2 A yam. '4 60pdigawK, Ali"ie.A.-14 o "' <br /> Anticipated Start Date: /74-....2‘. "- -0 ) (Home/Cabin;Commercial Business;Bedroom;Deck;etc) E k <br /> Building Contractor: .5e.../P Sewer Installer: ez 5-74ll d v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> b <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r-, <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed,from them prior to <br /> .4NY construction taking place Or any dwellings,dwelling additions,manufactured homes,manu/ixdured Z L4 kli <br /> home additions,and bunkhouses.* <br /> 6.61 <br /> ��`� t©�" � { YV\CA b� V\-(1.1)‘A-6.1:V. t o r\ <br /> J <br /> x Fee Rec: <br /> .4.35-P <br /> �Q <br /> Ni....__ <br /> Check#: LE56-1 <br /> Date of staff site visi te/ ©Init. of site visit staff: N m <br /> VAPPROVED BY LAND SERVICES OFFICIA : DAT l 1- =:„....---7-Dj <br /> r* wil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . c <br /> g. f'- tillV <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT gm _ <br /> Transcendent: - Page 1 of 4 ` o <br /> Laserfische: Burnett County, WI Land Use Application-Rev 6/2020 Li:Lit==�: <br />