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~ ' LAND USE PERMIT APPLICATION— Burnett County, WI c 2b <br /> Applicant Complete All Sections Below This Line c o <br /> Permit Types and Fees:(Please,check appropriate boxes) y A Fy°- 6 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 .: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ' i' <br /> 11 'r Accessory Structure(Garage,Shed,etc.) 2AS Addition/Alteration to Accessory Structure $150 ? <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r <br /> 5 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CID <br /> *NOTE:After-the-fa .- ••• •• ..' .. .'red after construction has begun)may cost up to three times the normal fe- `3 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> to <br /> Property Owner's Name: kez-r14_,\A, �o v d a Y z O <br /> 0 <br /> Property Owner's Mailing Address: I 6.) 3 Zf V`` 'J , mpIs mh ‘ <br /> ILo \ <br /> City State Zip <br /> PropertySite Address: 5 55 d rn v �n bv� <br /> c' 1 <br /> Contact's Telephone Number: L 1 a--%St .../a$0y <br /> . <br /> KZ <br /> Contact's Email: l Day\ <br /> Legal Description of Property: ik grD )CS 1 It $1 44 D0y\1„,,v 1 <br /> Section#: 2 O Town#: 9/ N Range#: /4 W Town of: ,s yam/Ses o <br /> 70 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number; found on tax statement): aa9' 'cc- te,�cIOV <br /> Proposed Use of Structure/Addition:Q.,1 84...0Q,y' �� 64k cn <br /> Anticipated Start Date: (Home/Cab‘ 14,0\.nt...4 <br /> ;Comm rcial Business;Bedroom;Deck;etc.) k. o x <br /> Building Contractor: Sewer Installer: <br /> d <br /> I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C ' <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to V <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured 'z M <br /> home additions,and bunkhouses.** . r) <br /> --3' <br /> --3' 'its ►S cth of t.✓' '/e-- -..�a.� e v 1• - - ,f sio/`4r� <br /> G0�-�'iIA' Se;� q'-IIaCiIl /Mike. , <br /> --� 54vlra e_ �Kralh PO use fid+ f 74 <br /> y14 USl- be_ /^70!/e So PO TAY'7%el f/ Fee Rec: �2J <br /> S e G Check#:021 .. <br /> 'ic C49 <br /> 71 <br /> Date of staff site visit: /O�/S/� Initials of site visit staff: Ac <br /> z <br /> o ,�Di <br /> APPROVED BY LAND SERVICES OFFICIAL: mow'• DATE: /0/9/ZOZ4 x <br /> r <br /> litirn <br /> UPON APPROVAL: AP ICANT MUST POST COPY OF rc W c)0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °y 0� IfR <br /> 00 <br /> _ <br /> Transcendent: - Page 1 of 4 rr m e R) <br /> w.'K" cm) <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 3 cz2 <br /> C <br /> a �/ <br /> 3 <br />