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LAND USE PERMIT APPLICATION— Burnett County, WI b <br /> Applicant Complete All Sections Below This Line ° N <br /> Permit Types and Fees:(Please,check appropriate boxes) P °- , <br /> —2- 11 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 NV <br /> - <br /> �/ Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 EJ�,Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � 0 <br /> j Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 L_ <br /> C1 $1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 << <br /> Filling/Grading $150 Boathouse $500 0 . <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 . <br /> CA <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = <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. 1 <br /> Property Owner's Name: .,,�('K n "t' J� - +65 e� o z 1. <br /> 92-1 s Rye II <br /> tu.t. , ��- 6 <br /> Property Owner's Mailing Address: o6. <br /> z r . City State Zip -a ( <br /> Property Site Address: 23?/4' d L.63 �l re. ) i1) I �8 1Z F. CA <br /> n <br /> Contact's Telephone Number: k,/ Z.- 74/ 305'(R <br /> L <br /> Contact's Email: �/,z/�erQ j, /j �F el/]/�1'1CU �, ep/�Y� o 'A <br /> g DescriptionProperty: ./.-01- 3 ' 0 of/� ' S 0 Cs m /4g9( Stedie. o <br /> �- , <br /> Legal of Pro e <br /> N 'a <br /> Section#: I toe, Town#: j g N Range#: � W Town of: Lj,/'1(6/S °__. °° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): 2 2-2.. L--. <br /> Proposed Use of Structure/Addition: aC.,1r01 <br /> .0 v) <br /> Anticipated Start Date: /' 1GLQ2/ J(Home/Cabin; <br /> Commercial Business;Bedroom;Deck;etc.) 71C" 0 x <br /> BuildingContractor: John '---- �i <br /> `f1r ti!%'1 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMINIENTS/CONDITIONS ONLY r— <br /> lab ts4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `V <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to �j <br /> AV"Yconstruction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> / 'home additions,and bunkhouses.** x <br /> A /p if UsC-01 e. -ar AN A.(a t 14A/tTL¢ 4M <br /> f/1 • �. <br /> arialeg- c u' Gill S> q' s cIY�e. kil <br /> 0 ,t) / CdGGQ/� Ol� f G���- 1Ni y s4/ oz/ <br /> ° <br /> Fee Rec: /6u � <br /> U Check#: /909 y <br /> o <br /> Date of staff site visit: ///3/2o Zl Initials of site visit staff: J 7 -i------r_-1.' <br /> APPROVED BY LAND SERVICES OFFICIAL: ft DATE: / /7 a i'7 < 1ilid <br /> 11 mt'7 1 <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF ' m ss jk <br /> 4.,3NO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT of CD c°, <br /> Transcendent: - Page 1 of 4 30. <br /> Burnett County, WI Land Use Application—Rev 6/2020 1 <br /> Laserfische: - "�`-" <br /> m <br /> E <br />