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r <br /> LAND USE PERMIT APPLICATION -Burnett County, WI <br /> cn IN) <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> 13, <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> c-- <br /> Dwelling/Principal Structure $300 ,e Addition/Alteration to Dwelling/Principal Structure (,,..,.w$20I --c-3 <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 Ir <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 9 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < k <br /> Filling/Grading $150 Boathouse $500o N �, <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 p <br /> C4 k <br /> In <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 /> Property Owner's Name: cf- rry d-Mes,vi cy /, O L vl/o L G..�V V rRt,ts r z t <br /> Property Owner's Mailing Address: // Kr- -f2-et kL a-ii (�(/��Cj'& 1J i 1 ? <br /> ( , 0 <br /> I City State Zip a <br /> v <br /> Property Site Address: • j , <br /> ,' _ ,�A _ I -A .� _ <br /> E <br /> Contact's Telephone Number: O o N le <br /> a C� <br /> Contact's Email: a. <br /> Legal Description of Property: .,cam ` / / .. <br /> P Pity: — �� e2 CQ �ICeC�'LC,C'l C, <br /> Section#: p2 G. Town#:3 7 N Range#: /(o W Town of: rne e yi, c>n 0 °Q <br /> 7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): ` q `,3 i. <br /> Proposed Use of Structure/Addition: 2 r�� Q/�c4-' <br /> Anticipated Start Date: e�t,L/v -o 11 (Home Cabin;Commercial Business;Bedroom;Deck;etc.) y � <br /> Building Contractor: �err'7' K©G/b Sewer Installer: <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c3� <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 bunkhouses.** <br /> 6 COMA 6'0 <br /> 0" 219l9 S 4o t arm 4--74(Pe- ,s eat pe cio,4%,ice. <br /> 61 Noel 14 4 Ai a*a I.D el'im t'r *6 r c:a rloom 4pe <br /> Y /i/ e9l. Fee Rec: "MI? <br /> v <br /> Check#: 01417 <br /> rn <br /> Date of staff site visit: Z Z Initials of site visit staff: / / <br /> Z6ta <br /> APPROVED BY LAND SERVICES OFFICIAL: '__„,& DATE: ?/ <br /> w <br /> uti <br /> UPON APPROVAL: APPL"CANT MUST POST COPY OF 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m o rt., <br /> Cult <br /> Transcendent: - Page 1 of 4 ,e Niv <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 <br /> L=J <br /> ro <br />