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f <br /> LAND USE PERMIT APPLICATION— Burnett County, WI 7 <br /> b <br /> Applicant Complete All Sections Below This Line o' cz <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> to �+ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 \I <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ' " "r <br /> ?<Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ O <br /> Accessory Structure(Commercial/Industrial) <br /> $200 Addition/Alteration to Bunkhouse $150 "� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground n ^^ \ <br /> Structures $125 WI State Statute 59.692(1v)Structures $350 , < 'J f�J <br /> Filling/Grading $150 Boathouse $500 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 j <br /> 1 <br /> *NOTE:After-the-factpermits c (� <br /> (permit squired after construction has begun)may cost up to three times the normal fee. �_ <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> CD <br /> Property Owner's Name: leXCH/MD l�,er-[w�i✓p z <br /> /S X90 , <br /> Property Owner's Mailing Address: /41+00 ace A -VY . /IN ..5ro3$ o <br /> City State Zip - <br /> Property Site Address: 93 i') A.,,,* sr. 1 bMb&p £44. S qt70 . ' <br /> Contact's Telephone Number: <br /> G'O �7s �' <br /> /^ "^32)'x$ < _ <br /> o r <br /> • <br /> Contact's Email: alGk. <br /> Ise Li r+(w^dc.,l 4.44.4V`t'L t co.r1 . <br /> CD <br /> Legal Description of Property:Sc.t.24—TN 4o i I4 <br /> Section#: Town#: N Range#: W Town of: <br /> 0 op <br /> *Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> i <br /> 7. <br /> Tax ID#(1-5 digit number;found on tax statement): 2Sos / <br /> Proposed Use of Structure/Addition: 57b`_i u. I C4 <br /> Anticipated Start Date: /0/e/20 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> a , y� <br /> � _ <br /> Building Contractor:Alar 4tIe�1� 9t 4 / ._ : Sewer Installer: /1/A-. i d <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 bunk oases.** <br /> Ot --\--—---0 0-- k-k-ONI\SI+, \.0\114\ -k k OY\ <br /> _- �d \\okiJ S\\ p(o- - Pie\ <br /> �\ <br /> Fee Rec: /5341)* <br /> U <br /> O <br /> Date of staff site visit: f <br /> .Is of site visit staff: 1 Check#: (ole ICS' <br /> r> `— <br /> 1? <br /> z l' <br /> APPROVED BY LAND SERVICES OFFICIAL DATE --.06 < it <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4, <br /> Ti -- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �' `� <br /> Transcendent: - Page 1 of 4 ;x ca <br /> ififil <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 <br /> Lc._____ .) <br />