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LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> N U 1 <br /> Applicant Complete All Sections Below This Line o <br /> a. <br /> I Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <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 Q <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° 0 lwrw <br /> I Filling/Grading $150 Boathouse $500 r- .) <br /> Six Montn Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 o <br /> K NI*NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. <br /> I*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,�J� etc. ,I i b <br /> Iv `Q \' A r c i c A ye. '1 �'V•bck <br /> Property Owner's Name:_ y Ct G , p` ( a ci J z r <br /> ,,.J o <br /> S- <br /> Property(cirr'ti Mailing Address: 2.5- -z 1 L ' S+r•' - k;Mb1 �) OA 55353 <br /> S- <br /> o ( . <br /> _ City State Zip b° 1 <br /> ii <br /> Property Site Address: S ‘ 7I-1- S-E-u+e R n 7 7 _ 7' n„ <br /> 4 <br /> Contact's Telephone Number:, 3 2 O—3 G3 -23 ( , 6 ( 2-21 C'l 3 7 SCce 1\-) c y <br /> c <br /> Contact's Email: d 5 v Yet ko a .. <_ M C7 <br /> Se-L- 17 "rn LH Rg 15 PRT 6.0 v Lv't-3 l..YG- N0 r= S t t-\ i <br /> Legal Description of Property: 77 EX ea Lt d' 1.1 <br /> Section#:_l_7 .Town#:__t1 1 N Range#: 15 W Town of: S W I S S a <br /> a <br /> *Attach additional page ij,,ceded for lengthy description OR attach a copy ofthe deed OR attach tax system property page.* d <br /> Ili4 <br /> Tax ID#(1-5 digit number; found on tax statement):- 2 t $to T.)' <br /> Proposed Use of Structure/Addition: P o\ tSo r CI (G o. -«ci e /S ' (G`q e> N <br /> J i —3 <br /> Anticipated Start Dare: ,rdt 20 2 i Wow/Cabin;commercial Business;Bedroom;Deck;etc.% E y <br /> a O <br /> Building Contractor: "3" Co.15}` ‘,,,A c;1 mc, Sewer Installer: Nt <br /> AREA BELOW'I'H1S LINE FOR LAND tiERVICES STAFF(:Ol\IMIJNTS/CONDITIONS ONLY 1} <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �J" � w <br /> "The applicant needs to contact their UDCInspector to determine if a permit is needed from them prior to M <br /> AN/i"construction taking place,fcrr ant'dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and`` bu;ikhousec.** l <br /> 6 /OW- ID @e LiJ . ct AIA lMc(f't ki A(D 17 7477e/if <br /> ., <br /> Fee Rec: 53•451- <br /> T' Check#:—J ,.z <br /> 2/ZZ72e z/ L <br /> Date of staff site visit: Initials of site visit staff: 7—/YG/ <br /> U <br /> cp <br /> tr <br /> APPROVED BY LANL)SERVICES OFFICIAL:__ DA.TE: 4,,.Y?..40.2d/ n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r �( <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m= 0 <br /> litilTranscendetit: l age I of 4 �, y 0 v: <br /> -------------- <br /> Laserfische: - <br /> Burnett County, WI Land Ilse ,application —Rev 12/2020 r v 3 N.> t� <br /> a, 3 <br /> ym UUU <br /> y <br /> LC—�J <br />