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LAND USE PERMIT APPLICATION - Burnett County, WI CA <br /> r <br /> < a b <br /> Applicant Complete All Sections Below This Line 6 A - <br /> Permit Types and Fees:(Please,check appropriate boxes) A a (/ <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 SI D <br /> ,)( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' - c <br /> g) t�, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ??hlUl <br /> Filling/Grading $150 Boathouse $500 r0 ' <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1Year Extension-Allowed Once) $100 <br /> ci) , <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. p <br /> rp. p <br /> Property Owner's Name: ✓‹/4/R,L E AltJ!!/ !'A vt /'Z - vZS� o o i <br /> /n/YLSYZ ,A4 n✓ <br /> Property Owner's Mailing Address: 8 9-S S -/t/1/67,e L /C 6 vt G,. <br /> 7-/z., G✓G 1i „5-7,---&-.7k„5-7,---&-.7k7, . 10 <br /> ; <br /> City State Zip b <br /> Property Site Address: S as-Lo3 T�1 1 t-A I D l .i 1.54:-; IF I n 1 <br /> 4 <br /> Contact's Telephone Number: 61.Z- Q hi .--rV 7[7 o c <br /> 3 <br /> Contact's Email: '/1; F <br /> L 6 R G;$R(A�FZ 0 6-",/a/2 /6- 1:--0:447:::> a 7.-:\d ' <br /> Legal Description of Property:1 '-- i C S ✓ /8 p /$ 7 (it 3 v if 623-C7 t om v <br /> Section#: i q Town#: <br /> q/ N Range#: /3 W Town of: S (-v ASS$ 0tl0 <br /> *Attach additional page i needed for lengthy description OR attach a copyofthe deed OR attach tax system propertypage.** °0 <br /> PS .f g Y P Y PS d <br /> Tax ID#(1-5 digit number;found on tax statement): 2. l t'1 to Si r) <br /> Proposed Use of Structure/Addition: s f 9 fin`fad A LCek P iT1Zct e r61.4,C <br /> Anticipated Start Date: Z.T .( kr /.S, 7„.40 / (Home/Cabin;442. 0 x <br /> Commercial Business;Bedro ;Deck;etc.) <br /> 7 <br /> (/ ['rC1Y47u S'!li �i/ C <br /> Building Contractor:�j/P ewer nstaller: / ” 7" <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: — t <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.** x <br /> • meek ali 5 0c it-5 <br /> a NaA- �r h N hc,bl - <br /> x Fee Rec: I t )htt? <br /> o0 <br /> ro Check#:1555) <br /> Li <br /> 7ai L <br /> Date of staff site visit:-i 12! 4'I iti.is of site visi`taff: z (�- <br /> 1a ____, _� <br /> 9,12.15A <br /> trl <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: < sn <br /> ff <br /> UPON APPROVAL: APPLICA_/ ' " UST POST COPY OF ai C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r 0 N <br /> Transcendent: Page 1 of 43 ... <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 '1 3 W <br /> CA <br /> ��----� <br /> a <br /> D <br /> b <br />