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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> t7 <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 /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 C- <br /> o r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v) <br /> rm <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. ' A <br /> r <br /> Property Owner's Name: 1.�(,t /�'7 • <br /> ,,`` o <br /> Property Owner's Mailing Address: < 5V Mo!. 1 �.a.�qE"Y� --, (,J,L ,5YJS7�.� $ ' <br /> C, � � �^' I City State Zi <br /> Property Site Address: 0 9/¶O mei ,�1-i'.- R-i. L b --71_41 -z1s9 E <br /> J/ <br /> Contact's Telephone Number: �3 ff- �'�ij(O- �7 O�6/ o F <br /> Contact's Email: „Iva,C'/ G/-e r�r+-Z;''-/- -- tL- T/4l./.6�'� d <br /> r. <br /> Legal Description of Property:i " L)r 6 (r,%t- ,'((j .,.cc,`4 ,t g L/-31 1/,z' <br /> L iv_ o 0. <br /> Section#: 1 Town#: �9 N Range#: f 7 W Town of: j, ,r e `✓1 =. <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): Ja? <br /> ` <br /> Proposed Use of Structure/•dditio : , .. c 1/1.— `n <br /> Anticipated Start Date: , i CA omelCabin;Commercial Business;Bedroom;Deck;etc.) (I .--3 <br /> k <br /> Building Contractor:4011A. 5 IN- <br /> I e-r5 Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7 O <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 t9-' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z D W <br /> home additions,and <br /> Lbunkhouses.**JJ / / Pc <br /> I'' / ri"' 6e. (i$ G� - r A N W1 Q N 4.10, �a y) r <br /> 2 % iVe,e land IA 5e. epi/f 6;" rn elm I 5e..)1 !,0Akit. /S LT' <br /> 10cq7 17o-61- 44,614 Of 9c?rcr, to 7 ..r///20f, Fee Rec: _>V _ <br /> Check#:3'3!o(o <br /> dtn <br /> Date of staff site visit: 2/3/Z49 Z/ Initials of site visit staff: 9►/' �7 Z.i z <br /> APPROVED BY LAND SERVICES OFFICIAL: WZIel ee ,7J L JDATE: Z <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF a 8- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r R= <br /> Transcendent: - Page 1 of 4 n w <br /> Laserfische: <br /> Burnett County,WI Land Use Application—Rev 12/2020 t m '._:-2 <br /> y <br /> y <br />