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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 6• <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v-......4 <br /> ic Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure _$150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `1.� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° r <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Per Year)g Unit(One $100 Permit Extension(1 Year Extension Allowed Once) $100 <br /> CID <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> I r g <br /> Property Owner's Name: Ziri ,f a , i)14- aid D c 14.s cob (1S(Sr o o 7 <br /> Property Owner's Mailing Address: 34'70 £4j d c.Ack-c74 *."'7r1 ti7N, 3-S-'8 0 —' <br /> ,3a 07_? c�'ja w Dr'I Y-• e "1,J City State Zip w <br /> Property Site Address: (A1 = n <br /> Contact's Telephone Number: / " V�(53 ''' LA:7 T .Q1 a - Ya&—?o Vcr o <br /> Contact's Email: i KIIn f` 6:04 yethoo -e orY` <br /> 0 <br /> + 9'r 0 <br /> Legal Description of Property:4I l'1nPtr.5Qv ren 955.7.5 o r•-3 i, Y3 # O.J�o}4 a� „# <br /> N <br /> o <br /> Section#: oZ7 Town#: ii-M N Range#: IS W Town of: S�7 S S 0 a <br /> *Attach additional page ifneeded or lengthydescription OR attach a copyofthe deed OR attach tax system property page.** m <br /> 1 <br /> Pb' f P Y P P h'PS d <br /> ci <br /> Tax ID#(1-5 digit number;found on tax statement): c a 7 P n. <br /> Proposed Use of Structure/Addition: SAee4 "' <br /> Anticipated Start Date: <br /> its c5ooe-as to 4rm4 t I :%C�n;Commercial Business;Bedroom;Deck;etc.) �� x <br /> Building Contractor: 4r'r'Qr1 ec4ri creel 6=-/P01-435 Sewer Installer: <br /> Cf <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY H <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place frtr any dwellings,dwelling additions,manufactured homes,manufactured z LA <br /> home additions,and bunkhouses.** z <br /> �$ ct(Q /444- , <br /> 1 <br /> �e�k �<< 5 41)�, 5 aill,f sS� <br /> ;Arra 4 b- �h�� <br /> V g Cara Cold":AeI5 tiNj Ce( If v5+ be Co✓1/1ec(ec or a <br /> /h* t Vteec eJ ( — Caf e ee74 4,/i� '' Fee Ree: /Sa <br /> 0 Cc 1' Pei 1/14 fS ckar fde in• s C4/1'11)1'1 Wick . j ,3O '4r ��L i S Check#: 3D�/ <br /> rti <br /> Date of staff site visit: " / 13 O/ Initials of site visit.t•ff. V z <br /> 1 / a <br /> c"....b4, rri <br /> APPROVED BY LAND SERVICES OFFICIAL: /0 DATE: 7`151> r <br /> UPON APPROVAL: APPLICANT ► UST POST'COPY OF Di a liVil <br /> E. <br /> r- <br /> SIGNED PERMIT APPLICATION INPLAIN SIGHT <br /> .< y <br /> CO <br /> Transcendent: - Page 1 of 4 m` w 0 <br /> Burnett County, WI Land Use Application —Rev 12/2020 w a <br /> Laserfische: - mrad <br /> a ca I <br /> 4 <br />