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LAND USE PERMIT APPLICATION —Burnett County, WIcr <br /> IV <br /> cn t4 <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> ‘s:(Please,check appropriate boxes) t' <br /> ncipal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> CD <br /> t7 1 <br /> //' ommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 e <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ,-t <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 p <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 a , <br /> Filling/Grading $150 Boathouse $500 t <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red 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. I <br /> Property Owner's Name: f [c <br /> iro <GA-z_e_(vv.\l;S._. e_t t l��4;w)' re k,k__+-evitvevev, o j <br /> Property Owner's Mailing Address: 741/._ G,`G-lika.L-ck_ e'—j 6. 1.e ..2-6101) . MI 17 50q., $ <br /> / City _ State Zip .0 <br /> Property Site Address: , .1-1'1 I Aoc�o r ..1-4A,.. 49.4-‘, LUQ b��-re is^✓ W.l 5yei�3 z <br /> Contact's Telephone Number: C,S[- Q 7O --3.40 <br /> y <br /> Contact's Email: Ai0,..v1, Ka+2 !Avv\0.l-ei^0 Cicf wtc.,LtirS-(-„ ;A d <br /> 'JulLegal Description of Property: L, 5, (n 1)$ .515 Leta L5Nl 33a9 l 14,M, 00c 316113 .. <br /> N b <br /> Section#: `� Town#: 3 N Range#: /5 W Town of: L-& i t�tt� .. 0° <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system propertyPage.* <br /> - <br /> Tax ID#(1-5 digit number;found on tax statement): I -7c)`: }} ri. <br /> Proposed Use of Structure/Addition: C2' t• ' vz <br /> p �c�wv�' v A�c�. Al F �nl�r_C _ r^0. t� , uc �_ -i <br /> Anticipated Start Date: ;T;wee„ aO;z 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) b o y <br /> Building Contractor: o fit` V.J.y 7 ��,-s) '-Crteic�� Sewer Installer: ,. <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 N <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured Z (1 <br /> home additions, and bunkhouses.** / wtc / Pc <br /> 4..., j) <br /> 0 POI- <br /> /ti kusP� 4r Alt/ li h al0/'' A�4, (b <br /> 10 ivia save- M e,t,a// to ck.S <br /> x Fee Rec: JCA <br /> Check#: 125,21Ty4 <br /> Date of staff site visit: �`'/ Initials of site visit staff: t rri <br /> ' r'—I <br /> APPROVED BY LAND SERVICES OFFICIAL: , y/_ DATE: r 74001 o .. I!uu <br /> UPON APPROVAL: APPL CANT MUST POST COPY OFZ. <br /> c o <br /> Iiiiii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = N <br /> 4 N Q <br /> Transcendent: - Page 1 of 4 Qr T <br /> Burnett County,WI Land Use Application —Rev 12/2020 <br /> Laserfische: - LC:= 7) <br /> a <br /> ro <br />