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LAND USE PERMIT APPLICATION— Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees:(Please,check appropriate boxes) A a <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150g <br /> A <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures (� <br /> y / pg $125 WI State Statute 59.692(1v)Structures $350 ' � <br /> Filling/Grading $150 Boathouse $500 C. `N k- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ' <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 /> *ltems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name:—aer-ter c. 41 A64-4y� 7 k21/5 ° Z <br /> 0 <br /> Property Owner's Mailing Address: 43eZ 1-(..), w{ckzvi Y _sr; Qw , ,orf n14/ _ 0 'g- <br /> City <br /> City State Zip ,a <br /> Property Site Address: g,9167 bvti 7c,vJ7sJ Zb, b"levz u e..y w= X5°830 " <br /> Contact's Telephone Number: „So7 -.4/57#-Q 7 38 <br /> CDCD <br /> a <br /> Contact's Email ,t)�— /5 f Ccs( i'l..k, / , (;ip,s! d ,�, <br /> Legal Description of Property: .Col"'(, C-5•11 V g 453—(27,/ c✓ /or 3,- sz 7ve) <br /> N b <br /> o <br /> Section#: / $ Town#: 4/ N Range#:/c W Town of: .... 1.425S °Q. <br /> ' <br /> 00*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property Page.* <br /> p <br /> Tax ID#(1-5 digit number; found on tax statement): '-1 94/ 4 <br /> F. <br /> Proposed Use of Structure/Addition: f ft& 63i1/ioV vAlb.ii Ajc,LsrmiC,4/G zn/ "' <br /> Anticipated Start Date: _57/5/..ti (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: L�-E., ,i-A, £ CepA/sp- L Sewer Installer: <br /> e , <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 _V— <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** x <br /> = Fee Rec: ,i�.'.c;C c- <br /> 011.7(..., <br /> 373ol�l L.--Date of staff site visit: , Initials of site visit tafm <br /> APPROVED BY LAND SERVICES OFFICIAL: •• DATE: WM)" , Im' <br /> UPON APPROVAL: APPLICANT� POST . <br /> UST COPY OF `^ � ,�, liiiii <br /> Ar <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> c# IV 2 <br /> Transcendent: - Page 1 of 4 <br /> ifThi <br /> Laserfische: Burnett County, WI Land Use Application-Rev 12/2020 ._. <br /> LL• <br /> a <br /> 4, <br /> b <br />