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LAND USE PERMIT APPLICATION - Burnett County, WI c b <br /> N <br /> Applicant Complete All Sections Below This Line 5' N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> t7 V R <br /> Dwelling/Principal Structure $300 )C Addition/Alteration to Dwelling/Principal Structure $200 <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 6' ° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G, •. - <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .c (CJj <br /> Filling/Grading _$150 Boathouse $500 ; lb <br /> ` <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 N` 1,." <br /> c4 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. p <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. - FP <br /> i"I 0 v is sly); t-t' z <br /> Property Owner's Name: /� <br /> Property Owner's Mailing Address: 3 'I 7 cotylj- kol A. I± Ciliq3 o <br /> �n <br /> City State Zip a. <br /> Property Site Address: ?9 ''I C 0 vn l-/ k A_ t ?ID,--/-- Gni+ C-11-6''i 7 is <br /> cn <br /> Contact's Telephone Number: 1 I S 5-C9(.0102, <br /> S /7,.,,, "► o <br /> a <br /> Contact's Email: -1--,,--1--,,-__t,„ 4.- �`�..Z � v 1 Kul0 Li A . C-c.) kz"1 � d <br /> CD <br /> Legal Description of Property: r 0 o str $ I U 3-) Vi 'p I` <br /> N "v <br /> Section#: ;,)3 Town#: 4 0 N Range#: (' W Town of: 3(,r ck_f Oh °= on <br /> S' <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system property <br /> Tax ID#(1-5 digit number;found on tax statement): -- <br /> Proposed Use of Structure/Addition: c.5 Gr-R.A.ek Po,- LL,4( . V^' ` <br /> Anticipated Start Date: /14 Aka) Z /s2 `v <br /> / a (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Em <br /> x <br /> Building Contractor: T CA=n-I 1-'i'`�'`''' Sewer Installer: W <br /> .0 „,, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY e ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Cf.‘,(1**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.** d <br /> 07141S pearIAA, 1.7'- iS �r a Ia 74.4ActI CXPati5io+n Up 7' 24010 s' ri; rs <br /> OHt 4,974be- rQ44IOv / ktn lake51' e. pou`c'h, 0ilia\ <br /> wt'I1 co tile; 5fruc/ure, q+ 3S � e. Oh'b w! , ?\ <br /> 2 va d ' ? ew% IAA 7`7a)'ioV\ Pe v' plaIA v'er�t ✓ N 0?00°% <br /> �j�i1oJ Nt� aH /'a�H ar slide s Fee Rec: <br /> 3 /UdeQ iv app - .t^ a VaNIui c-Gr 40 lakes1 ., �g. l4,o/ W4fk o Check#: a` '.3I <br /> Dafehf stays e-vi�si? ' CP ZO ZDZ itials of site visit staff: p7;-- <br /> CD <br /> APPROVED BY LAND SERVICES OFFICIAL• DATE: 7/1/zc Z....1111111W rAa <br /> ififil <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i <br /> 10o o <br /> m = o <br /> Transcendent: - _ Page 1 of 4 �y <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 - L_:' <br /> ( 1 <br />