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• <br /> C4 r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI <br /> w' r N <br /> Applicant Complete All Sections Below This Line ae <br /> c. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `- <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 EO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 o , <br /> Filling/Grading $150 Boathouse $500 o d <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v <br /> *NOTE:After-the-fact permits(permit aquired 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. ? i 1 <br /> p Y ?::Z.0` 'JO c <br /> Pro ert Owner's Name: ii w�_ `` Z <br /> Property Owner's Mailing Address: 1321 1 LtetN. h.) 1VW /6v& Mn 55301 c <br /> Cy City State Zip <br /> Property Site Address: 2 -1(035 / ioesNJck C tcCt2 (0O.40b ) \N't= S'iS&) n <br /> Contact's Telephone Number: 6 . CO \Lk k L\ < F <br /> a <br /> I. <br /> n <br /> Contact's Email: SpaS.3\ ,U el.( --CG3 MaN l 6 Cy_6 , S <br /> Legal Description of Property: C� 1. t2szserAla. ` <br /> ti <br /> Section#: 3 (47Town#: `—{, j N Range#: 1,5 W Town of: 5 W 155 <br /> 674 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C <br /> s <br /> Tax ID#(1-5 digit number; found on tax statement): 3 L ct S 9 <br /> p Sid `� .� <br /> Proposed Use of Structure/Addition: —i <br /> Anticipated Start Date:'5)1' to 2..0 (Home/Cabin;Commercial Business,,Bedroom;Deck;etc.) o <br /> R � o <br /> Building Contractor �(1� 'D Sewer Installer: (�/ -, <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 ija permit is needed from them prior tokA <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** 'Po <br /> it avrapac NAS' +6 k used 'Fey' h 4wwa t 14a6•4A4tON. <br /> b CAwpr mutt- loe rew d MIIess pawl- is actstrece. <br /> ki ttcf c perIA4i' rum heed 4r deck occ ccumee r 4. 918/2020. Fee Rec: <br /> ui5 <br /> Check#:,3e <br /> Date of staff site visit: 00020 Initials of site visit staff: a <br /> APPROVED BY LAND SERVICES OFFICIAL:0/14 ATE: $6//3010 n <br /> UPON APPROVAL: APPLICAN((((((// UST POST COPY OF : r_ <br /> rn <br /> rn a m CV <br /> -n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r- c 0 <br /> Transcendent: <br /> Page 1 of 4 v <br /> Burnett County, WI Land Use Application—Rev 6/2020 3 o j[rjj <br /> Laserfische: o , �----- <br /> -o <br />