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• LAND USE PERMIT APPLICATION— Burnett County, WI a `°cn <br /> Applicant Complete All Sections Below This Line 5 o <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `� W <br /> , Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> XC <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $1500, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <° <br /> Filling/Grading $150 Boathouse $500 C- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. • m <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. .--r 3 �A <br /> Property Owner's Name: .1)AV t l� AM) )IAM O'We LLti '�/ <br /> - S-r o <br /> 1 <br /> Property Owner's Mailing Address: /1=3 Z.g LA(ocoIV LANE- kiN, g5iFe vu l 593 6 <br /> 0 <br /> City 'State Zip $ <br /> Property Site Address: "75ZFS L.AE:co1V LA&,'E F. r <br /> Contact's Telephone Number: 71 — --Th i -L 0 9 o @ <br /> • c <br /> Contact's Email: a CLV CI. a r P_O e � qm1 M I ✓ c ril ), <br /> E�i6"/E( oW LAKE- L LTA <br /> Legal Description of Property: LQT 7 4 'l uo ..:r.r i N our ►x 15 1 4- Z. <br /> Section#: z.9 Town#: 46a <br /> N Range#: R I 10 W Town of: uAkl-AND 0°• °Q <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): 14 3'I C� ▪" <br /> Proposed Use of Structure/Addition: T--ORA `� <br /> Anticipated Start Date: NQV Zb"2O (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E▪ x <br /> ' ,r site prepg o <br /> Building Contractor: (Vicei vik/9 SiJS) Sewer Installer: N //r <br /> -3 w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ?•3' <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 bunkhouses.** I'm <br /> • leet tkire_., FleodLi" 'zQre.e.w...2tom.i- <br /> I• li ( &k&&%\ 1 1't �c5)\ 2 Fee Rec: 15 <br /> N Check#: jct.,.Ry___- o <br /> r. <br /> Date of staff site visit �/i��^ Initials of site visit staff: a <br /> o <br /> J v.' s— '`��-'�"J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: CD�;3��� a <br /> RI <br /> CCI UPON APPROVAL: APPLICANT MUST POST COPY OF u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y 0 i- <br /> -C m c N <br /> Transcendent: Page 1 of 4n .-e o Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 n 3 NI <br /> a <br /> LTJ <br />