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• LAND USE PERMIT APPLICATION —Burnett County, WI f b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) ." a - <br /> Dwelling/Principal Structure $300— Addition/Alteration to Dwelling/Principal Structure $200 d {W� <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 � O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r- k) (] <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o pCj <br /> ( IP <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. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> I ' p 0• 1 <br /> Property Owner's Name: ,_/, A n. (l—c;r,r, tAk o <br /> Property Owner's Mailing Address: /j.' )`Y �j��' "'/2/t &-' l z/:��,�, /'1 ../ ,_,e-jr y, °o w <br /> Cify State Zip w N <br /> Property Site Address: 21.;,:5-',22, r/1/, • ,._.(e hi Li•fie /V, -7.4.5n,�.- °' n N <br /> Contact's Telephone Number: 9,542— 22/ 2 uhfo <br /> Contact's Email: JO X—. <br /> X—. //� �:r�yl /r722�i ��1/11A1 d <br /> f L, "e-,/ ! j <br /> Legal Description of Property: l C' � / ei T <br /> Section#: t Li Town#: �cl N Range#: IL/ W Town of: yC t.4,,,)k <br /> ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> 411 <br /> Tax ID#(1-5 digit number;found on tax statement): LC .JC;(7 r) <br /> `"Proposed Use of Strcture/Additi : / <br /> Anticipated Start Date: (f7.-//5- -- d (Home/Cabin,Commercial Business;Bedroom;Deck;etc.) <br /> uo iK <br /> Building Contractor: d�/17-e/- K'� �j <br /> Sewer Installer-. /r�� r <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 /Gtbunkhouses.** <br /> x' <br /> ** <br /> — piNff G /100G /100e six roti'>-/oi9 a c74f /s'1 <br /> ►e_ q,0t�1/a/ 6Dl/' Val/Ic?Ne� MR-19-P. <br /> / -// . <br /> / <br /> x Fee Rec: co <br /> 1 Check#:131r) <br /> 0 <br /> m <br /> Date of staff site visit: i08/7.0/9 Initials of site visit staff: )1/ t z <br /> — <br /> tri 4 <br /> o ��j <br /> APPROVED BY LAND SERVICES OFFICIAL: _ DATE: 730/ZOZO < r- <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF i-1 go <br /> 51 <br /> a o c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r . 0 <br /> .0 Co G� <br /> N <br /> Transcendent: - Page 1 of 4 g w a NJ <br /> Laserfische: Burnett County,WI Land Use Application-Rev 6/2020 2 ' �' <br /> u <br /> LL- J� <br />