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. MI-fid <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a b b <br /> Applicant Complete All Sections Below This Line o a o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 1 <br /> v) <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 /> 1'7 ) K 1_ �A/ ��S c, .. ,. <br /> PropertyOwner's Name: <br /> Property Owner's Mailing Address: ! U 90 L/71 Alo P1 t-Tsy Ail 55`Pi-L a'?o <br /> e• eity State Zip -0 <br /> Property Site Address: to Li / 3 L-, //y e.1 prze _ 9,„,‘,„,...„� 64../.1.: 3.--y ' 5. <br /> Contact's Telephone Number: 6 / e/ 7- 6 3? o <br /> N <br /> Contact's Email: / )C /7f4/E/Z.3 (Li�f/a0- fO'� d <br /> 0. <br /> w <br /> n <br /> Legal Description of Property: hi----6 <br /> N 'o <br /> o <br /> Section#: Town#: N Range#: W Town of: 5 w 1SS ± OAtcAND 04 <br /> 5' <br /> "` <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system property page.* <br /> C7 <br /> Tax ID#(1-5 digit number; found on tax statement): ,- U-(o i 7 4' / 13 <br /> Proposed Use of Structure/ u V ddition: t' el.C.14bAdi "' <br /> -- <br /> Anticipated Start Date: 1/Z,Z -?"/Z- (Home/Cabin; ommercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: l;V-{IA au,c. /p rj&.[ Sewer Installer: f.e_4 .5 G14,t.i,'42cv i <br /> 1 -iAREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ' 4) <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 .N,. <br /> home addit' ns,and bunkhouses.** tt P <br /> _____17, Vu ly\i 'rOc 1\6_3 �w�CV0.ThOV\ \i✓L <br /> is <br /> Sow\ foot-VISCt CJS )C i S t hoQ - <br /> Fee <br /> 5. Rec:o2 Q V 442 <br /> 6, Check#: 7:17 <br /> 9, iji, , 4-1.- <br /> Date of staff site visit: [ v ^� J Inis of 't <br /> tiale visit staff: <br /> f 0 r.,,_,..,./„.s.' J <br /> q m: <br /> APPROVED BY LAND SERVICES OFFICIAL: — TE: 6�I 7 ? m -r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF tl 0 <br /> �I <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Lc <br /> O <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: Burnett County,WI Land Use Application- Rev 6/2020 -----�I <br /> cmo <br /> a <br /> a <br />