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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> v N <br /> Applicant Complete All Sections Below This Line =' c 0-+ <br /> Permit Types and Fees:(Please,check appropriate boxes) °. <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 U� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> ,.....c. <br /> Accessory <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $15000 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° N <br /> Filling/Grading $150 Boathouse $500 t: - <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 5 <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 /> NI C1LIUCiC r <br /> Property Owner's Name: • 0, <br /> J i1 , I 0 (` <br /> Property Owner's Mailing Address: W l�1 D N E ' L R D [iMDSC J w I SLIC N F N. <br /> fit,` -2) <br /> C City State Zip $ <br /> Property Site Address: 'i`( ,,) Pmts.. �J p N B(�,{oo /• <br /> E <br /> Contact's Telephone Number: 1 IS• -Q,1,' 0991 . or <br /> • c <br /> a. <br /> Contact's Email: r i c of e V u kLC '7^' J m <br /> . N14 a '1 y. <br /> l i•coCLU V <br /> Legal Description of Property:V I' 'i I G j)(' V ' 3 PI 0 <br /> N b <br /> Section#: 2C Town#: 00 N Range#: /7 W Town of: U IN !n A, 0 w <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): a-- 15010 <br /> Proposed Use of Structure dditio + i�ti;t t C Pt N i <br /> Anticipated Start Date: (Home/Cahin,;Commercial Business;Bedroom;Deck:etc.) k <br /> Building Contractor: cS‹ Sewer Installer: NI <br /> y , <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 10 � <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additio s,and bunkhouses.** xi o xi <br /> (Vee look 4 C�la.in G r+ '`' --gal i,( l <br /> e 4, ex 3 b r r�5 Pe( SA'N 8669 <br /> x Fee Rec: c0U)— <br /> IJ / r ) o Check#: 33('') <br /> Date of staff site visit: _I Ia{d'l Initials of site visit staff v <br /> cm <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: ;„,,e/;„,,e/ i / /' DATE: idoi?-i o <br /> < 0 <br /> J C7.3 <br /> UPON APPROVAL: APPLICAN . ST POST COPY OF <br /> a ° D <br /> -tri m c. , <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° �3 <br /> Transcendent: Page 1 of 4 F c NJ C <br /> Laserfische: - <br /> Burnett County,WI Land Use Application—Rev 12/2020 azN <br /> o m <br /> V Lb <br />