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LAND USE PERMIT APPLICATION— Burnett County, WI a 0 b <br /> _ Applicant Complete All Sections Below This Line 5 o <br /> Permit Types and Fees:(Please,check appropriate boxes) c- V <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e <br /> - Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `" <br /> ye Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ^t.... O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structureso <br /> $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> — <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 /> ' <br /> co ov <br /> Property Owner's Name: e(') 4 �..(,Sk . r CDla.netA z N <br /> ii i <br /> Property Owner's Mailing Address: ea 2 }-b�(o Loci..., L7A ,2,IcwQ S'` 1 0 u• ,&4O (, 3i'O7 $ <br /> � City State Zip <br /> Property Site Address: �je 1(PGr P� LZ�C �. p,-3 Qy '�' 54fs36 5- rn„ I <br /> Contact's Telephone Number: 314- �foc- 10 5.1 o - �` <br /> • g <br /> Contact's Email: JcCfss'. Kfo?otla,A C PIcokc'rc-t-cd, Cows o N <br /> P4 1. <br /> ro <br /> Legal Description of Property: 2e F016 rt.cite Itk-e)oti I o }' 3 .. <br /> N -o <br /> Section#: t', Town#: 4/ N Range#: 1 CR W Town of: iS w.SS = °0 <br /> A. <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): a 2 o q <br /> Proposed Use of Structure/Addition: 67 A It A ch f 1 "' <br /> Anticipated Start Date: 9.)s)t (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f x <br /> 0 <br /> Building Contractor: g,,,k„, Sh-4-4 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 if a permit is needed from them prior to CP <br /> l:NYconstruction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** z <br /> bi <br /> M -0� For 14G, ii �'a� 1or1 <br /> Fee Rec: 4 iSti <br /> l. <br /> cr Check#: t 5 N., <br /> 0 <br /> Date of staff site visit: V.-- <br /> '�A itials of site visit staff: r\-k > ------3-7::::—___-_—_-;? <br /> APPROVED BY LAND SERVICES OFFICIAL: 1CATE: C) <>, �� � 10 <br /> .:1-:73- 1 › <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 'TIa ¢Q) <br /> >=i ' cgs inni <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT e <br /> Transcendent: - Page 1 of 4 -i- o <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 _ �.- `' <br /> a <br /> 3 <br />