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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> Applicant Complete All Sections Below This Line t o <br /> Permit Types and Fees:(Please,check appropriate boxes) a C:-f <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 dkj <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "Ci <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 , Addition/Alteration to Bunkhouse $150 R <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- G <br /> c) <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 E.: <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 occesso tructures,such as:pergolas,landscaping,etc. - <br /> co illi <br /> Property Owner's Name: '\._ i at) Q.k • <br /> ,11 ZL , <br /> Property Owner's Mailing Address: ...01-i a_ EI�r,C se' kVG,t1J �°caLv �le 11C. 55 13 <br /> 2/ / i'l Ail <br /> D Sjate Zip n t <br /> Property Site Address: !� /NeelAt IAA / q vt!p(fi^(/ F: <br /> Contact's Telephone Number: 6 5 I -03B -"C 2 o c <br /> Contact's Email: 9iT <br /> / p !� <br /> Legal Description of Property: Let- <br /> / C 5/1 2Y <br /> c N b <br /> Section#: 36 Town#: 1J1 N Range#: /6 W Town of: Su)(, S 8. cm <br /> w <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property Page.* <br /> P <br /> 9 / a <br /> Tax ID#(1-5 digit number;found on tax statement): 3,336' <br /> j,�6' L/ 8' <br /> Proposed Use of Structure/Addition: L"i'I(,,tt'C' )1/1 r‘ e___ c, <br /> Anticipated Start Date: LA( ,�(�o10 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.). oTo g K <br /> 'd C� 1 <br /> Building Contractor. I _ Sewer Installer: C� k. I ^ <br /> AREA BELOW THIS LINE FOR LAND S VICES STAFF COMMENTS/CONDITIONS ONLY y �% J W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z VI <br /> home additions,and bunkhouses.** / / <br /> -- ' 1,15 5/rlAv%(� / S coHs/dam' G bup1�Aoti e, <br /> _.- ov ic' y 4� t� 7Af ,t,� �w,i0(,�ne_x__, Ly <br /> q/30/2.02.0. <br /> :4, Fee Rec:a <br /> 5 A5-6P4) <br /> #: <br /> 5151 <br /> Date of staff site visit: -7i ZOO Initials of site visit staff: //i <br /> Iftikk <br /> APPROVED BY LAND SERVICES OFFICIAL: �-w— DATE: 7/70°20 yi c <br /> w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF >'> <br /> 0 CaU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT fr <br /> Transcendent: - Page 1 of 4 = m <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 I c <br /> ro <br />