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C4 '71 <br /> LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5'0 � - <br /> Permit Types and Fees:(Please,check appropriate boxes) -. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d p() <br /> 'T Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 _ <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 co 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 V� lv <br /> Filling/Grading $150_ Boathouse $500 r• C <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c0 <br /> *NOTE:After-the-fact permits(permit aqui red 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 /> 1*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> j I r. 1 <t <br /> Property Owner's Name: ...��j at-c-.4 \�c,.p�i%-k, L ° o 7- <br /> Property Owner's Mailing Address: 3F O Nal-1-4A. t lice t J I'`/� 3 23 0 <br /> 0 .. 7( 1 . _j City State Zip <br /> --c-- <br /> PropertySite Address: aVF G� 0• r <br /> Contact's Telephone Number: 6(,a- QQCO •-'oL74 o <br /> a <br /> ��,(, t� <br /> Contact's Email: eIJG.1/L�C7ZS a r `Me'se t {'. ✓l� �/ Loi-a 691 V'1 P 3.�' <br /> o <br /> Legal Description of Property: 07 o9 cam- a-(4O - IL(-i Q --Y 05---w9- o t 5 ) C?) .. <br /> N 'a <br /> Section#: (C( Town#: -PAC) N Range#: 'R(Li W Town of: '7 -Cy-I-- 0• °° <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): I t 944c, (?) <br /> Proposed Use of Structure/Addition: 1x *vux>5(' ce,p: ,f v, <br /> -a -3 <br /> Anticipated Start Date: 0-31- ,��( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: Sewer Installer: <br /> a d <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.** ( L m <br /> 0 f\10+ -�( hc.,I 16/1 kG be.-- , 7 /) 001-J510e- Sri' encQJR vef,e vtl s%rows�`bll <br /> d� S.Ze !hove/' <br /> 4w 4or�! O d-t • <br /> 10- 7zi? <br /> ov <br /> I>J Masi .4tAu.e 'oe; VSCd' o Fee Rec: �f� <br /> s, G` , o Check#: bg 307 <br /> tr <br /> Date of staff site visit: I 0ll 1.I Initials of site visit staff: IN r_ <br /> +J cn <br /> ri <br /> APPROVED BY LAND SERVICES OFFICIAL: ,' .�/%/ DATE: ag a �< kj?' ', <br /> / � • CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF "+ '�3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I o `J' <br /> at Transcendent: - Page 1 of 4 ia N C <br /> Laserfische: - <br /> Burnett County, WI Land Use Application—Rev 12/2020 <br /> b <br />