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LAND USE PERMIT APPLICATION— Burnett County, WI . ro <br /> Applicant Complete All Sections Below This Line 6� c o <br /> Permit Types and Fees:(Please,check appropriate boxes) ,---j <br /> d <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Fi) -& <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 iO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150pi <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 64;r r <br /> KDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <° }vim <br /> Filling/Grading $150 Boathouse $500 r- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn — <br /> ra <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. o. <br /> *Communication Towers&Si9ns 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 /> cik 0 <br /> Property Owner's Name: Tec/:CNUr� /11i//SS4 /`/i f' o Q <br /> te�3l!,„,, `� <br /> Property Owner's Mailing Address:A/53.4 fS#3T 1,4166-,e, a IV.L )/ 71 $ <br /> A n 0- <br /> City State Zip <br /> 7 k11 <br /> Property Site Address:wigs? 6,,,-,74/4/c6 lez6-S$ ✓` rtit I Jerk t -t S' 7 -.. vni <br /> _ EA <br /> Contact's Telephone Number:f c 6/5-2Z2-f3S ) o G \ <br /> CD <br /> /� O. <br /> Contact's Email: `aujeiJec / (tom,, o/, w,'L,L0sir► d <br /> . <br /> o <br /> Legal Description of Property: 56-e- 51(r uec f ill lip <br /> N -io <br /> Section#: /fq Town#: 37 N Range#: / 3 W Town of: 73e/ME 69 A e °_ <br /> 0 <br /> B.- <br /> .additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C7 <br /> Tax ID#(1-5 digit number;found on tax statement): R..3 4/(0,5- ' <br /> Proposed Use of Structure/Addition: ,/,ni, /G/9hi. <br /> Anticipated Start Date: -� -� <br /> p �?/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> A/OT ‘trc a5G— c <br /> D ' = d <br /> Building Contractor:6I/1/fel /'pc-/-n-7i OA— Sewer Installer: (.(AM <br /> AREA BELOW THIS LLNE 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 then prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured zr <br /> home add'tions,a bunkhouse4.1),* hi,l `fa u b c, coy.....,a 4 d he b ill-(kr 1977. <br /> ---7'D 1l q m s- - <br /> C A 5 FT '5et"br-L6C rc y h(s)dn -1'aerk.K.._. <br /> bakeIc S <br /> T Ma' <br /> Fee Rec:,3 <br /> Check#: TI-7,> <br /> bt010)15� 1\104---- <br /> Date of staff site visit:/l 1 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: t'k —TIATiJ o , `' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 aTa E F <br /> 0 n � (nom <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° o o ,; •U=,u <br /> O <br /> Transcendent: - Page 1 of 4 7, 3 o <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 m ? _ - IM <br /> � <br /> 1 <br />