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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> a Applicant Complete All Sections Below This Line 6 <br /> CI- , <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> CD <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 \ 0. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e 4� Z <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 /> cn <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 /> _ I 1 <br /> Property Owner's Name: /p -0 r `— S 1(i ,V L K �N\- (� o <br /> • <br /> Property Owner's Mailing Address: J 37Z G fs.P n 1 Lit-) ofiij14-(c utiS� <br /> ° <br /> ° <br /> l, ^ I L� City State Zip b <br /> Property Site Address: 17: f"( ' V oy� a. <br /> cA <br /> C\ <br /> 4 <br /> Contact's Telephone Number: 6z I �– 9 \–S40 i''' o c <br /> l\` 0. <br /> Contact's Email: *w % A(c.,..02._s e clhll.►ik1 L-. r 60 d <br /> Legal Description of Property: 4-1 /#: Al(� W Town of: • 'l(kr \ 1---M4-1---M4- . t 3 <br /> Section#: Town#: t"{© N Range 4 • N b <br /> °c °O <br /> 5* <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR• • • • stem property page.* O <br /> • i i n, <br /> Tax ID#(1-5 digit number;found on tax statement): ---- "Eir_ <br /> Proposed Use of Structure/Additipn: /K / 0 "' jar , •114 ' (') +00,s _ "' <br /> --1 H <br /> Anticipated Start Date: 3/..2.:, ,Z,/3 ?CYiHome/Cabin;Commercial Busin- : •room;Deck;etc.) t. ° K <br /> 1 !.V d <br /> Building Contractor: 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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured Z <br /> home additions,and bunkhouses.** Ixi <br /> 0 /Vo7`' it. u gt -1w/' h H MAati) f/1 Q 6 i�7a 74en, <br /> el 7 ISS /tS 7v p /Oc c774 /1t e--- e t. Y r ' V Iy Iv <br /> , <br /> a Gow.pllG'A - lou{74opt , 54ed pletca by 100°P^ grab <br /> Fee Rec: <br /> 01�Y1 e,� IA /Y-4 int f et PGI`L✓t IY. cA Check#:(6J <br /> m <br /> / r <br /> 3' <br /> Date of staff site visit: % 440°4 Initials of site visit staff: 17; //l v/ [ � <br /> rd <br /> APPROVED BY LAND SERVICES OFFICIAL: ; DATE: WZe`'( < 0 <br /> rnn p .V. UUU <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF z W x 011 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 'oIffli <br /> A C p,,,, <br /> Transcendent: - Page 1 of 4 •c t.....) 44 <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 ?. Iiiiil <br /> L ) <br /> 4 <br />