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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> yit...) <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < 0 r <br /> i <br /> Filling/Grading $150 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> T 11 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. o, <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 /> p Q <br /> Property Owner's Name: Tt�,p,/r a 5 a yl(,C A.,1*I as ca. a(k. 1 e v o . <br /> Property Owner's Mailing Address: l 0 3`),'-1 C(e s-t'(1 t2 P b( ��1 AO elbiika.. N .. 5 30.`S g <br /> f n City State Zip 0. <br /> Property Site Address: .3 O55 41/rick L' dl <br /> s e P-.& <br /> row- 4 <br /> Contact's Telephone Number: //Om e c1 5 a —S'? / $'Yj c t l G S/- 3 4 - 1 C0 i 9 -�- p G WI <br /> Contact's Email: bafbc)Y ('itO nt (,Q l(� Irl/ 1 , cow d ICD <br /> ^ <br /> Legal Description of Property: ?et_ A C 5M V t r 95v6 <br /> Section#: a Li Town#:''7/ I N Range#: !S W Town of: 5 c v r SS o. a,* <br /> � <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> C). <br /> 4 <br /> Tax ID#(1-5 digit number;found on tax statement): Fi <br /> Proposed Use of Structure/Addition: 8ecL(a0m f\Ccease,) st0(acl�f R ODMS J n@c k p <br /> Anticipated Start Date: <br /> p (�,/�p J..1 (Home/Cabin;Commercial Business;Bedroom,Deck;etc.) � � � <br /> C • . <br /> Building Contractor:CON C 66 e Cortsl•of AilitmaAte Sewer Installer: <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (31 <br /> Vi <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 <br /> home additions,and bunkhouses.** <br /> I �' <br /> Dwe l <br /> l - est... 3- 1)64� o 2s <br /> x Fee Rec:4Z 5° <br /> A <br /> Check#: coil <br /> rn <br /> Date of staff site visit:11/a!7/ d I Initials of s' a visit staff: E ► <br /> 11111'0 ' , <br /> / 5/3/ / ^ <br /> APPROVED BY LAND SERVICES OFFICIAL: 1�rl /�� DATE: c uuu <br /> UPON APPROVAL: APPLICAN UST POST COPY OF ' 0 <br /> ,..., IR <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° - o 1:014 <br /> Transcendent: - Page 1 of 4 r...1Burnett County,WI Land Use Application-Rev 12/2020 i i ^�1 <br /> Laserfische: - d <br /> i <br /> b <br />