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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line 6� c <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ... 1 <br /> e— <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a(j F <br /> Accessory Structure(Commercial/Industrial) $200 teration to Bunkhouse $150 !T <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse ../ $250 pj ., <br /> n 'Q� <br /> Driveways/&Campground Structures $125 ute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 t <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> v, ..' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ° <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, andscaping,etc. eD '10 <br /> o <br /> •p <br /> Property Owner's Name: : , 4 . t r — 6 / bkI 4, L6k. 7( -z‘ - <br /> Property Owner's Mailing Address: 11 V .. ii •. ki r 5 , a 0 <br /> Q Cit} 1 State Zip <br /> Property Site Address:a 7 y 'IJta � Lane_ l,✓Q_!�' -ter tui �� <br /> tel/ <br /> Contact's Telephone Number: 12j. O C.. ' *.?-7(0' EU l� C c <br /> a <br /> Contact's Email: 0�1.5h$ Ili 11 5 ilh (,c 5-1--f .i _ v o <br /> Legal Description of Property: Su, \luci tat <br /> N <br /> as <br /> Section#: 3 Town#: 410 N Range#: I S W Town of: (AUe6S4(YI 1'& Sohl <br /> B. <br /> a <br /> *Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> C <br /> Tax ID#(1-5 digit number;found on tax statement): '6?__?3 <br /> tiC <br /> Proposed Use of Structure/A di}�on: ^ <br /> Anticipated Start Date: D/iSid a w ' CA <br /> (Home/Cabin;Commercial Business;Bedroom Deck;etc.) i x <br /> Building Contractor: l f Sewer Installer: 11)( g 7 <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 U1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufacturedZ 1 <br /> home additions, d bunkhouses.** ^ �� L\ O <br /> ----t7' t o Woe c/ O umb i n) �(\ T�v h��I�L —�-) <br /> --' j Record g till . //a+4,$e A, reem.e''`-t-- h'.3 <br /> Jed V� i S'a.o a_o . <br /> x Fee Rec: <br /> / e <br /> Check#: 3 '{0 <br /> rri <br /> Date of staff site visit:/0'( 52—, -OP" Initials f site visit staff: Y— z <br /> jj�� o <br /> APPROVED BY LAND SERVICES OFFICIAL DATE:/t/ I�—oa�aao < <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> e m = C:23 N <br /> Transcendent: - Page 1 of 4 x o o cra <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 6/2020 m 0 0 cm <br /> C1 <br /> .=. , <br /> b <br />