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. LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \ L <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C (...— <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> zn <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. <br /> ( � • r _1" <br /> Property Owner's Name: J 01)n will ll a y41 , .. <br /> ' � o�E'• <br /> „b.:. <br /> Property Owner's Mailing Address: 61, l y �,��I'1 f %, �j / '/(/ . <br /> City <br /> ���� �� t j Zip 57. <br /> a � <br /> Property Site Address: e /�oce.)' R/ �/�7�.7' j ' v <br /> Contact's Telephone Number: 6i ` 74 3`i / 7� u� •o <br /> Contact's Email: E 5,c7075-7 7J 6 6/3#9 a 1/ <br /> 7--' 5,c707 © 4ri) m.p <br /> Legal Description of Property: Le)'T' J id 6 JAI 9 V far 7c2 73 4310957 CD <br /> N 0 <br /> Section#: a Town#: ya N Range#: /(2W Town of: 04?if/4.?") I _ 0 <br /> cm <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): <br /> /3 53 6 . <br /> Proposed Use of Structure/Addition: e/� 4 til, <br /> ,,, <br /> Anticipated Start Date:pe4> / ae, (Home/Cabin;Commercial Business;Bedroom; eck;etc.) , <br /> 3 <br /> Building Contractor: EMC e1$6h ilt2/2 <br /> Sewer Installer: la.{ / <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <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 t G <br /> 0 <br /> ome additions, an f bunkho ses.'' <br /> ale use.. ..e.47 <br /> e.c a// st.i.e4c4.s. <br /> 0 No -67/1 Ny/gV'ackNS/ to/Y--4 ti SD ,ei-- a tei 71--he, ©t l tii4 <br /> 0 g1,, AN�1 P1. - i/` ,3 be j0 1M s fes_ <br /> / x Fee Rec: <br /> y Check#: 3-7 <br /> 'o <br /> Date of staff site visit: r' Z/ z� Initials of site visit staff: ! a <br /> CD i <br /> 4! <br /> APPROVED BY LAND SERVICES OFFICIAL: - DATE: Z .?-12 < 0 <br /> m -- <br /> Effl <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF -9 a ' 'z 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - �o = <br /> . R.3I <br /> Q <br /> Transcendent: - Page 1 of 4 n 3'< <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 S F <br /> o <br />