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r4 e <br /> LAND USE PERMIT APPLICATION—Burnett County, WI c <br /> b <br /> 1 vN <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) - ° I W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c L9...) <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 f <br /> ,Zs.,_ <br /> J C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 { I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ..'7: 1-..._ 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °. I� !� <br /> I1' � . <br /> Filling/Grading $150 Boathouse $500 b <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 ;'mm <br /> cia I1 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. § In- <br /> a. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc b j.D <br /> • <br /> Property Owner's Name: 41 i kE e C i,i L i lJ i h , t i o 1 <br /> ,,/� / P1 Mo;�-fl,i N <br /> Property Owner's Mailing Address: l(p L i Wes 4- .I V `R.8 i (.i A-e Let icbz p F kv e 55,f L / 2 O �-- <br /> City State Zip . , <br /> Property Site Address: � 112.5 Wk.l ttv E IRA i i Fre d el- t_ (U 1 s is 7 �' 'K, <br /> Contact's Telephone Number: Co CZ l Cj -LlO Li-L e -A----.) <br /> Q. <br /> Contact's Email: S kid j J 0 M e e eN con \ e/iYvc I -Co <br /> J , <br /> Legal Description of Property:L.0— . F I f 0-1' U)e s zc ii. i r4' 6 .' i r i <br /> Section#: (Z Town#: 3i N Range#: lb W Tow of:Tr a 6z. c e- 0 <br /> *Attach additional page i needed or lengthy descri tion OR attach a copyofthe deed OR attach taxsystem property page.* <br /> P S r f P P P PaS y <br /> Tax ID#(1-5 digit number,found on tax statement): 33 3 1 8 <br /> Proposed Use of Structure/Addition: C fl?I N . 3 t,,2 d r©o t y 1� <br /> Anticipated Start Date: 7v 1 ( [ (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) <br /> ri0Building Contractor: ✓ , vt 1cSt Sewer Installer: I j ` iC <br /> -3 I— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i� w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1ICA <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to I 1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z 1r <br /> home additions, and bunkhouses.** z 1 <br /> l>3 Pieci- aR se-- betcius 1 <br /> h �e ll�� iv eie,e, <br /> nab- 3 b&rodh s <br /> 0 J <br /> Fee Rec: jCD <br /> d Check#: I(024 <br /> m <br /> j I <br /> Date of staff site visitL �2 7/ \ Initia of :ite vis' st. i, r a <br /> APPROVED BY LAND SERVICES OFFICIAL: /.^ DATE:5J�/?t m rUPON APPROVAL: APPLICAN OST COPY OF a a M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g a N fill <br /> Transcendent: - Page 1 of 4 cr..3rc:=Burnett County,WI Land Use Application—Rev 12/2020 < m,� ti <br /> Laserfische: - m 3 <br /> dm <br /> J� <br />