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LAND USE PERMIT APPLICATION—Burnett County, WI 3 b <br /> Applicant Complete All Sections Below This Line a- c p <br /> Permit Types and Fees:(Please,check appropriate boxes) o 4 <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v (` <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '`-30 <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 /> li <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Cam One Per Year ° <br /> in <br /> P g Unit( ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. E ilk <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 /> rA <br /> Property Owner's Name: bvtct Id L. d- MOO/ V M,e1ra S 6.14T-ola i`.e4 I a oL'. <br /> Property Owner's Mailing Address: 33? nTCyf;tc,E 1--ckos A i ban'/ /V ll 5‘. 7 i O <br /> QQ p� a , NW <br /> Property Site Address % (Q j 1E l tMc"OI� Cc`CLI� Ctt D �ut Vr =• n 1 <br /> 3a©-3 1 , <br /> Contact's Telephone Number: ' u©,)3 CoriC`tiCTc c )1s 79)—b39S o <br /> Contact's Email: y V ' �cyxvTCctCTcs rCC ',� -,2 CO. <br /> Legal Description of Property: Z07 / C 5IAA V. '7i'17J v es <br /> Section#: ii Town#: 110 Al N Range#: 15 W Town of: *-\12<-:k5ar1 <br /> N <br /> 9*Attach additional page if needed for lengthy description OR attach a copy nl'the deed OR attach tax sy.tem property page.* <br /> U. <br /> Tax ID#(1-5 digit number;found on tax statement): 3 i ( E. Q, <br /> Proposed Use of Structure/Addition: 11aME I C.c b t t" . A <br /> Anticipated Start Date: b-1-X80 IHonte/Cabin;Commercial Business;Bedroom;Deck;etc.) f x <br /> Building Contractor: w - <br /> -\ H'(' To <br /> r\ Sewer Installer: >/I C t1<GQVGTi`rU <br /> J — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 additions,and bunkhouses.** z 0 ' ' <br /> 6 /via <br /> kt4tst- y.4c.-ek et 11 'wild etu1S /Hel4 c4tt'C� i"9-47/0 Sdisack. <br /> © Ale 77, ex_ 3 ow.Q p eic I. t''Y1M 1/ <br /> DDrlivetNay 7V wice-+ ter,/rew► rvti5 by i 1 /S/Ze,Z1, <br /> z Fee Rec: `D <br /> i�q „o A }1 d()� o Check#: <br /> li' DD <br /> cm <br /> Date of staff site visit: f/`�f/`I`nitials of site visit staff: <br /> MY - <br /> z . <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: _ _ DATE: /Z ?/O G�/ < r i / / <br /> ! M = <br /> UPON APPROVAL: AP ' ICANT MUST POST COPY OF co rn 16---_,,\h) <br /> $ 5 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Z C a jou <br /> Transcendent: - Page 1 of 4 xo <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 7' o <br /> �: <br /> o = ; <br /> -.. _.- <br /> • <br />