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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o 5, c <br /> o <br /> Permit Types and Fees:(Please,check appropriate boxes) ..:: ,:k....;.. <br /> on <br /> Dwelling/Principal Structure $300 x Addition/Alteration to Dwelling/Principal Structure $200 I 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 0 <br /> r Acces •ry ru, re( • ,jo c. • tr. ) $200 Addition/Alteration to Bunkhouse $150 ' el <br /> %/ ' 1 o .7 7 i 'i t` , Bunkhouse $250 r _ <br /> a tri u WI State Statute 59.692(1v)Structures $350 1 <br /> Filling/Grading $ 0 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After the fact permits(permit squired after construction has begun)may cost up to three times the normal fee. F <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: g9 L.y s7/7- A> w ° z r <br /> (� <br /> o <br /> Property Owner's Mailing Address: 2)36 y L t J XP 1,t9)5l;S T/&'(--- IA)/ 5',n3 o <br /> City State Zip0 " <br /> Property Site Address: $/}v^i t = n <br /> Contact's Telephone Number: 5"/ - ,..5-,e 7 -,c3-3 y <br /> o - <br /> c <br /> a <br /> Contact's Email: ZT Z1(/ S'14-021‘) Q G A/.9/1._ , C "1 <br /> a <br /> 0 <br /> Legal Description of Property: lc-r- 1 C 5 ri if 3 P J 5 3 ( )u (,-o V i. OT -7) .. <br /> Section#: 53y- Town#: 4/0 N Range#: /5 W Town of: f4-.S o i'-- _ °0 <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* "� <br /> PS .f f SY P Y P P h'Pe p <br /> Tax ID#(1-5 digit number; found on tax statement): 2' <br /> Proposed Use of Structure/Addition: ofiar�'IIIIIIIMP ;) ' r- -. P OWl e l-to frA <br /> Anticipated Start Date: /j4 i P (Home/Cabin;Commercial Business;Bedroom; tc. �q�, 0 '' <br /> f = d <br /> Building Contractor: Sewer Installer: <br /> -3 <br /> AREA BELOW THIS LLNE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: )1.-- (6-3 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to UI <br /> A.VY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured Z <br /> home additions,and bunkhouses.** Pv <br /> • I-61'1 e ada t-i-i OYt J(o o 'k S S Gel()to,C2wo9_41- o n IN( a r\d <br /> C \\ps v ow-,-ked, ?\&- Ock V\ Fee Rec:13-2s� <br /> r ��€q�p _ <br /> o 0 o \r0 Cc �,r--03 `,\X\y. 1 . _,(--,e,.."-\¢ �� ©� Lc\ke Check#: 5.27 7 <br /> Date of staff site visit: ] —690 of site visit staff: V CY-- .. <br /> APPROVED BY LAND SERVICES OFFICIAL:t <br /> ' -_- DATE:' t ', b D -; giiii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> fffil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .a a <br /> • Q <br /> Transcendent: - Page 1 of 4 . 3 c2 <br /> to IM <br /> Laserfische: - Burnett County, WI Land Use Application- Rev 6/2020 <br /> 0 <br />