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.14-e Id ; _HS 5ij 4 24 D9 <br /> LAND USE PERMIT APPLICATION -Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 5 a <br /> Permit Types and Fees:(Please,check appropriate boxes) CD <br /> Dwelling/Principal Structure $300 x Addition/Alteration to Dwelling/Principal Structure '$200 O <br /> Cx <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure `$200 <br /> X., Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �\ C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse ($250, G-. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures 350 e° pi <br /> Ft <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension Allowed Once) $100 .�s <br /> cn <br /> * OTE:After-the-fact permits(permit aqui red 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 /> 7+: <br /> �' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: T7ojLS Daren 41012- Oe , at%/ S ° p i <br /> Property Owner's Mailing Address: /1p2.5.. (*"y 6 3 F evvJalChMO4( u/.z.''Yvi, 8 <br /> City State Zip -0 <br /> Property Site Address: 2-;(0 1` it 5 t ret--) r (` i y $ 'f 7 Z c <br /> Contact's Telephone Number: i`7 Z 3(3 — q ci y t o 1 ' <br /> / a <br /> Contact's Email: dO.rrfr CA V1 S �Z�Q c.L C(� . to,-‘- -�` d w <br /> Legal Description of Property: 07 vok- Z -) -1)- lip -5- Os- -O Y? - O2y0oo , C <br /> j <br /> N a r <br /> Section#: /v Town#: 3g N Range#: ( `i W Town of: rDtk rt 1 eLs _. °G <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): Z 2 <br /> Proposed Use of Structure/Add' ion: 4-(c•Nil e 4— De -4c1\e d Cay-45..e rn <br /> Anticipated Start Date: lit /5 ( 2011 (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) <br /> � e <br /> Building Contractor: DGi/revs /a�1 S Sewer Installer: 4 Ia eg y 24,P <br /> --' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY lk <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 from them prior to N <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.**, I , <br /> 0 6 cwtt9e— /'1 o,- 7v 2 NS� -GI "A u tMQ� er /7-004 , <br /> g 4/ea 4cie/c t/14 eye S c074c 4/4n, 4y 6 /2o 2/; <br /> y 4tb2 t <br /> Fee Rec: <br /> iCdiettLo <br /> Date of staff site visit: <br /> 7 g ge9 Z/ Initials of site visit staIP _dipff: /, > W3 <br /> Z <br /> CJ <br /> inz <br /> APPROVED BY LAND SERVICES OFFICIAL: ,�r./_ DATE: 0Z/211Z" < r <br /> n w <br /> ET a <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF > W <br /> < 3 �' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y CM) <br /> of T <br /> 00 N <br /> Transcendent: - Page 1 of 4 , <br /> Laserfische: Burnett County, WI Land Use Application —Rev 12/2020 < g <br /> ^ z ffil <br /> a <br /> 4 <br />