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LAND USE PERMIT APPLICATION —Burnett County, WI a CD <br /> Applicant Complete All Sections Below This Line o • o <br /> Permit Types and Fees:(Please,check appropriate boxes) e. <br /> ' Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 b <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 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :CD <br /> ; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 '��., j,1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o1111 <br /> • <br /> Filling/Grading $150 Boathouse $500 r-- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 • <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> • �\Property Owner's Name: JA16 7�D►A-tv�lt_ ��� • •z <br /> ---------- -- --------- ------------ --- <br /> 10 <br /> flL,.. <br /> Property Owner's Mailing Address:_ 72-72-40 /4(DOH 4U Q0,.•)_ C.'r �/"� -, y55ll2 <br /> City State Zip -a ‘ <br /> Property Site Address: 14,X"AX S4JA L414E --0245. —1--,-A-1 1.- tilc"73S"Tc .Ji_-_511643 d <br /> Contact's Telephone Number: 7 S^ L11''cY22( E4 <br /> 4 <br /> Contact's Email: c- -- D74 .e...O, o <br /> v <br /> g_ <br /> Legal Description of Property: (...-==.7$ S 4 8 61,^)04-A- 5412x.-r <br /> N <br /> n <br /> r <br /> 'J <br /> Section#: 0�T Town#: 3c6 N Range#: /S" W Town of: LA-FoLI.E"TTE <br /> Lt <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertypage.* <br /> 5 <br /> Tax ID#(1-5 digit number;found on tax statement): f 02-510g <br /> Proposed Use of Structure/Addition: E/ .4C3i.,1 C4 <br /> _ / o -- <br /> Anticipated Start Date: (G/j(p/2� (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) y <br /> Building Contractor: 741 tr e_sarR•cP7 Sewer Installer: 14.4.4-A 0 COh-Wa-- <br /> I -3 <br /> AREA BELOW THIS LINE 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 them prior to c— cN�, <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** / / V ` <br /> g/l9 7r2 o'P/ly " 1"' a S/ /- cr9'd s4y /2/3i/zezo•/A 57L pi eiT '.f0 ' �i 6,act�- GeUcc5S s�l d7 <br /> Z/75-0 a►Ad z'L75? Sattd QLD )1oo4e.S 7 /. / <br /> 0 Roo-r I'� 6e, P"CAAS'7� ;Mee Ifo L16.4,,111' 111""17- Fee Rec: C�CD <br /> 0 N <br /> Sq In I�Tcl COLe 7t p -4" Al • r4 Check#: • le <br /> rn <br /> Date of staff site visit: ���� Initials of site visit staff: �/// z <br /> APPROVED BY LAND SERVICES OFFICIAL: , DATE: /1/CADW < I– <br /> F) <br /> n D' ITEI <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF cn co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N , <br /> , CCD C . <br /> Transcendent: Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 rr 0:0 iffl <br /> 3 <br /> o <br /> a LJ <br />