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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o' c <br /> Permit Types and Fees:(Please,check appropriate boxes) J a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1 <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 /> Acc• sory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 7 tairs/Patio/Retaining Wall/Sidewal� * Bunkhouse $250 ,,- <br /> Zi7 <br /> Driveways/&Campground Structures �91Z5 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r- <br /> 9,o p <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c <br /> NOTE:After-the-fact .ermi .- ••' _ _ - .• .,'on has begun)may cost up to three times the normal fee w — <br /> *Communication Towers&Signs require a different application form;see corresponding app Ica . , .n• ees. 4`41- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro i <br /> o <br /> Property Owner's Name: M t del e l }-e�d i N eube(+ o <br /> Property Owner's Mailing Address:I1 g i 1 F l Ush ing ►- LIS c . Lct Lev i L le MN SSULf <br /> ' L <br /> J City State Zip a ` <br /> Property Site Address: 312..0-7 S-k p es Lc:.kle R.d E• <br /> Contact's Telephone Number: (_p(2-ago-(DO©n `` a <br /> Contact's Email: YYj E-}MeLl.be r-} O@9rna-I I . CO 1^r1 <br /> d <br /> v <br /> Legal Description of Property:Sec O7 Til 4 l Rg IS Lc t Z CSM 4 W(22 VOL 2/ P 132. AS <br /> • y N b <br /> Section#: Q'7 Town#: LEI N Range#: I S W Town of: S y J ISS c S C S(E.r-7i,C col_ °C <br /> c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*- <br /> Tax ID#(1-5 digit number; found on tax statement): 35 I SO ' <br /> Proposed Use of Structure/Addition: �' <br /> p DES'•K <br /> Anticipated Start Date: Cc1 n.l P 1 e+ed (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) X <br /> C7 <br /> Building Contractor: own e,r- Sewer Installer: 1/VCtd R(..k shO(m 1 t) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMI`IENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N ‘s% <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 �7Q <br /> home additions,and bunkhouses.** / / z <br /> 0 De f L 1MGc.7 — 5 f guider `�',s 4 6///zo3/1 <br /> o y y <br /> QO // h ex-al 71-vs 0 6/744A 'e enmi `- - ,0 ca wy ee, <br /> /// Oz/, Fee Rec: /?7.7. 56 <br /> y ceU <br /> s <br /> Pi <br /> /./ Check#: 3333 <br /> Date of staff site visit: 3 3 Zd Z/ Initials of site visit staff: ///G/ Z <br /> =_, <br /> O <br /> APPROVED BY LAND SERVICES OFFICIAL: TE: 6� < �'^—r <br /> 347' o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFca, 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z o0 o � <br /> -c m c N <br /> Transcendent: Page 1 of 4 T r3 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < m <br /> 1151 <br /> T N <br /> C <br /> 1.....c....-........j)3 <br />