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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5 o <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 b <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 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 74 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 k► <br /> Filling/Grading $150 Boathouse $500 r. Ilk <br /> Six Month Cam One Per Year ' <br /> in <br /> p g Unit( ) $100 Permit Extension(1Year Extension Allowed Once) $100 <br /> cia <br /> R <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. b — <br /> r 2 <br /> Property Owner's Name: i)AtJ, ( `j e &..1 ° z <br /> Property Owner's Mailing Address: f.O. lex t 6, kki5{e r livvi&. SycT q3 g <br /> City State Zip $ <br /> Property Site Address: �y"�,]6 l CON,.i Cf, i,(',k�,, K <br /> P 651 275 5) � < <br /> Contact's Telephone Number: o r, <br /> • a <br /> CD <br /> a. <br /> Contact's Email: <br /> Wer.\\'i � o <br /> Legal Description of Property: JCC 35 1 4/0 L- 16 C;fn iry, 4,-V.23 f' 0,}' .2 ut <br /> w <br /> Section#: Town#: 7Q N Range#: %t;+ , 3 <br /> 3S W Town of: Oa.Kik N c C' 5u)i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): 35123 <br /> Proposed Use of Structure/Addition: ()(I. .St-le.d v, <br /> o w <br /> Anticipated Start Date: 15 y1C,4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: KOtACt�trrirA t..) Pieta' ) f Nc, Sewer Installer: NArte((U, et O <br /> 1 `� <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 <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes, manufactured z <br /> home additions, and bunkhouses.** :n k <br /> 40/1c 5ittd wrF 4o be used For kwut'au Walef'tt4 <br /> Fee Rec: /sO` <br /> Check#: /(45. <br /> Date of staff site visit: <br /> 00020 Initials of site visit staff: Z � r <br /> APPROVED BY LAND SERVICES OFFICIAL:� (d DATE: // 02D < r- ��Al� <br /> UPON APPROVAL: APPLICAN ST POST COPY OF m> ,_,, . ,:, 03 L <br /> 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c=1 crifi <br /> -<' V2 >_ <br /> Transcendent: Page 1 of 4 n c <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 ` -3 r <br /> r <br /> 0 <br />