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LAND USE PERMIT APPLICATION—Burnett County, WI a t-, <br /> Applicant Complete All Sections Below This Line °. c <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CDw <br /> _c <br /> ommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `A <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> -» . l'IlA <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ID <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ' <br /> 111 <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. <br /> �—M.. a <br /> / , <br /> Property Owner's Name: / itpjyrtie5 ale.s. ....cd4-el-- 0 1 ‘ <br /> Property Owner's Mailing Address: Za 17 L14(e_csv[ety Cf6Lqi „c / / $ i <br /> _ ,• � City State Zip b A <br /> Property Site Address: 3oVb .s L - R51?t4- LA/,G-E> 7. t <br /> Contact's Telephone Number: 7C c-45-1 - 6,0& Z_ 5 <br /> _ <br /> Contact's Email: --61.142i../i../ (`f'_II *zed" <br /> le ? yeth_01• CC/70' o. <br /> Legal Description of Property: C 1 e 73 c1,t, - fe j ii (t) ., <br /> Nb <br /> o <br /> Section#: <br /> Town#:ai ,/ N Range#: /Y W Town of: -,W, v 00 <br /> °Q <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> C7 <br /> n <br /> q <br /> Tax ID#(1-5 digit number;found on tax statement): 33 0 Z__ ` 8' <br /> Proposed Use of Structure/Addition: E Xt 5 r I N /2.7c /So -A 12./1) S ne-A�g 5.1f '9 `,, <br /> Anticipated Start Date: "'1-2,0 Z4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.).V � ..-i <br /> �e <br /> iz9 <br /> Building Contractor: K($T�/ttir(3-- Sewer Installer: -3 <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 I <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** �' <br /> -----V. 01/60! AI FoK [Fwv(1 licti'''fa/71(1 <br /> Fee Rec: bu <br /> J�� Check#:5 <br /> Date of staff site visit: 9) — (0WI <br /> a01)0 Initials o site visit staff: IN\Vr- <br /> 8 8 <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL 1ii.,./. a DATE:"').-' 3 ';oa O CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFt�itt1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 'm N <br /> RI <br /> Transcendent: - Page 1 of 4v c N <br /> Burnett County, WI Land Use Application—Rev 6/2020 11 c: Q <br /> Laserfische: - 'Z <br /> d <br />