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' LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> • <br /> tr, t4 <br /> Applicant Complete All Sections Below This Line o o <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 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 p O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures Fe e) <br /> y pg $125 WI State Statute 59.692(iv)Structures $350 °e <br /> Filling/Grading $150 Boathouse $500 r- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(lYear Extension Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. cn lb= <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc g p^ <br /> r v� <br /> Property Owner's Name: F O e" J�t?weLI,_ ° o <br /> Property Owner's Mailing Address:1 S 6. WI ve .9 it)c,p, l ane. H t.;A s c WI 5 9 0 <br /> o <br /> o. <br /> City State Zip <br /> Property Site Address: S a,8 3 P c .r 1S s-[, lk) cx n be ry 1,j ... .' <br /> Contact's Telephone Number: �j 5\ '- ),T8 — �O 5(o5 1 r-- o <br /> i 1—— a <br /> CD <br /> Contact's Email: r U, s-t o w e.\\ 60 51,c._ c a bR\ e `c'tet v <br /> Legal Description of Property: F.CL Gov 1_01' 1. <br /> 2 <br /> Section#: Town#: N Range it: W Town of: 00 <br /> ZS y o gt U t\'.0 Let 1 .. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number;found on tax statement): as 0 5 7 ' <br /> Proposed Use of Structure/Addition: v e.\\• Lit p�.c ��Y t h < �,t ut`)z <br /> Anticipated Start Date: k I.,I?.0/ AD (Home/Cabin;Co in ercial Busss;Bedroom;Deck;etc.) F <br /> E7 <br /> Building Contractor: S IN c T.m a" Sewer Installer: N A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .—, k) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q1 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to (.11 1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** po <br /> a' F a Itol).) SkAvvv`Ae4 Vo44-- QI6A <br /> ' Otr-i" Fc;r ,4-1--knutr\ _, . <br /> 1-4-,--(--,ction, <br /> x Fee Rec: C5g) <br /> Check#: 5�b('J ' <br /> Rm <br /> Date of staff site visit: ----,)4 ---,;10,4lnitigls of site visit staff: I11"-- 0 <br /> a i_ w_ <br /> ' " -_ - C)l-dam Q r <br /> APPROVED BY LAND SERVICES OFFICIAL: '� DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF U <- <br /> Y c' N n.) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo N <br /> Pt v < p <br /> Transcendent: Page 1 of 4 No <br /> Elifii <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 '' z <br /> L JJ <br /> b <br />