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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line o• " N <br /> G o <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w �J <br /> Commercial/Industrial Structure j300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> )17 (Accessory Structure(Garage,Shed,etc.)ZZ Addition/Alteration to Accessory Structure $150 O <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ‘ <br /> Filling/Grading $150 Boathouse $500 , <br /> Six Month Camping Unit(One Per Year) ° <br /> /// p g $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> TNOTE:After-the-factpermits `" <br /> (permit aquired after construction has begun)may cost up to three times the normal fee. 5 �— <br /> *Communication Towers&Signs require a different application form;see corresponding applica ion, s. w <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o <br /> g (6 <br /> Property Owner's Name: -kSSS 4 M E LAN 1 E SENS p 1% z ilk <br /> Property Owner's Mailin Address: ` I I S M;A pev 0. ,,vt (.(1 04AI:w ry WS o 4 ' <br /> 3o25-7 /r ' t�YWq )- t„,4,0 City State Zip 0 <br /> Property Site Address: <br /> Contact's Telephone Number:, c ?3-2 12`Z7 S' I MELAP 1 E 70- 399 8982, ` o F II <br /> Ka:. o <br /> Contact's Email: �je^!aD(i t9 7 q � HmkNL0.� ( ,, Le� V <br /> cc t/ <br /> i?" <br /> it <br /> Legal Description of Property: 54-breLie Cah,1-4 0-el 1Q' Z 6 u/r Z7 <br /> 1 '?, '13 <br /> Section#: ( 1 Town#: j N Range#: /CO W Town of: 5/A,/ � <br /> *Attach additional page ifneeded for lengthy description OR attach a copy °° <br /> P g g y P of the deed OR attach tar system property page.* t7 <br /> Tax ID#(1-5 digit number; found on tax statement): 3 5 42) <br /> Proposed Use of Structure/Addition: 5+ePail Co VI <br /> Anticipated Start Date: (Rorie Commercial Business;Bedroom;Deck;etc.) o ''i/Cabin; <br /> Building Contractor: Pk Sewer Installer: N/A >I <br /> C7 <br /> ( -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY VJ <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.**/ Pv <br /> /�v�' 7v rod - r4uunctH A4bt'474di , <br /> les 1'5 ell a-F -14 e -- c1 p 't..` .1.1 <br /> Fee Rec: lu <br /> y Check#: <br /> Date of staff site visit: 1 I 13 ZoZO Initials o to visit staff: j/7: <br /> 0 <br /> am Gr.clay, 6,61.04 -' <br /> APPROVED BY LAND SERVICES OFFICIAL: Ail& DATE: /0300Ze , <br /> su <br /> gig <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF g w CD Cb' <br /> C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 'o .- <br /> cpc f .2r...) <br /> Transcendent: - Page 1 of 4 +w <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 _ 3 0 I�' <br /> L , !: <br />