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." LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> F 7 N <br /> __ Applicant Complete All Sections Below This Line $ a <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v 0_ <br /> f\. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ O <br /> N � <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n �[� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° V' <br /> (Filling/Grading $150 Boathouse $500 <br /> !Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cm <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,landscaping,etc. <br /> ro 1. <br /> Property Owner's Name: 132-"14Iv 5 R4M .t (�� /����/1 ) {_55444+___. a <br /> 'ropeity Owiicr's TN/lading Addre s23312i Y kt4OUgNg ' �i N. Lif�Fl�VII/W 141" 0 <br /> n,� <br /> City' State Zip -0 <br /> Property Site Address:@4Qtt��,,,, II���I�ll by IN's F. <br /> _ 3 <br /> Contact's Telephone Number: (647-i,(3(43 'Z2'Z9 _ <br /> • . <br /> Contact's Email: 13 Z-►'I itivIlia e.,1• is v'coriA i`\ .. <br /> o <br /> CD <br /> Legal Description of Property: S ! frll f' --_ ___ % �� <br /> Section ii:.__-�. .�Town /l:--4__N Range it: "'. 1 W Town of:_—, --- _ -�711� <br /> 0p <br /> ~.Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax II)#(1-5 digit number;found on tax statement): 5-247 7 r. <br /> Proposed Use of Structure/Addition: 1 _ I+E �— - - I_3 <br /> Anticipated Start Date _E Y (1louce/Cabin;Commercial Bus,i,ss.Bedroom;Deck;etc.) I1. °s pi <br /> Building Contractor: _ - e Sewer Installer: —_r I <br /> AREA BELOW THIS LIN OR LANStRVI ES STAFF COMMENTS/CONDITIONS ONLY -� (r. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed front them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured 7 <br /> home additions.and bunkhouses.** l� I� <br /> 0 A.171-- usece -N Akl PA kJ/34,590'n 0'n 1 <br /> 0 Sep t sys is est- chic 1Lc j, needs lo <br /> II -- i a ?,/ , -� <br /> Iote- � �/ x Fee Rec:��.-. <br /> y N <br /> Check#: _53L/ <br /> E, <br /> Date of staff site visit: /i.. /ze Z/ Initials of site visit staff:__—_ tt// 1/ —..__ rni <br /> c <br /> APPROVED BY LAND SERVICES OFFICIAL:_._ DATE: 2/Z720Z-4,ZO4, z QII <br /> UPON APPROVAL: APP CANT MUST POST COPY OF .. � <br /> ' w 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° .. <br /> 11 <br /> Transcendent: Page 1 of 4cm <br /> Laserfische:___ Burnett County,WI Land Use Application—Rev 12/2020 r,r <br />