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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> . <br /> a b <br /> Applicant Complete All Sections Below This Line 6' o <br /> Permit Types and Fees:(Please,check appropriate boxes) c '`'� <br /> _C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> >"c Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ` O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 uis. 1 m <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350$500 o <br /> Filling/Grading $150 Boathouse �. <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 N <br /> C4 I <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 /> Property Owner's Name: Mi c:61 ( •=/- D v' h 4 'F.�- S D Ai ° z <br /> y <br /> Property Owner's Mailing Address: 'i?/5- (3v .__,2.14-44..Q ri,.,c c / t,e../e4 5ieig to, 37(8'13 0 <br /> City State Zip <br /> Property Site Address: 54144.e.- . n <br /> 4 <br /> Contact's Telephone Number: 657-,2)(,, _ Sf(orj'( <br /> 2. <br /> Contact's Email: 14-1 t(<.4_4_e fe ,s,,/4,q At,,¢€ f, c,,,,,., d <br /> Legal Description of Property: 1 5� J ¢J e.��P 9 <br /> Section#: x,23 Town#: 4-/(j N Range#: /S W Town of: "J 1-c.-tsSv N <br /> 0 oa 1� <br /> 5' lb <br /> *Attach additional page i needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> °4 <br /> Pg f % Y P Y P P tYPo g <br /> Tax ID#(1-5 digit number; found on tax statement):, 78/g . _ ._ <br /> Proposed Use of Structure/Addition: ,5/Dn4 fe /2 (X / t 5x to 54,71e_ Sit e V . <br /> Anticipated Start Date: 4v7,-)..91-- (Home/Cabin;Commercial Business;Be&room;Deck;etc.) o x <br /> Building Contractor: It-'- t 6744 - C it:fewer Installer: -I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY b <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 O <br /> home additions,and bunkhouses.** <br /> * SlAgd, %A+ 411 be d Ar lltu wLM k.joi ie.+Iou., <br /> x Sf ruciktre aveoc& IAd& Orler 14e 4.cfr pevtigyy tart be dalec! I <br /> ip to �14 +he Ot/l 44 4e) = Fee Rec: l�(D <br /> K Check#: 53q' <br /> 0 <br /> Date of staff site visit: R,/3 2426 Initials of site visit staff: t I <br /> • <br /> il <br /> APPROVED BY LAND SERVICES OFFICI• • DATE: $05/3020 . a <br /> CD CO g 0 <br /> CD C <br /> UPON APPROVAL: APPLICA !. UST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' ° <br /> C N <br /> Transcendent: - Page 1 of 4 - m <br /> Fiji <br /> Laserfische: - Burnett County, WI Land Use Application— Rev 6/2020 <br /> mt LI�JJI <br /> o <br /> v: <br /> K <br />