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A <br /> LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes)' °' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t. ca0 <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 i 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 J ° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. <br /> cn <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 /> o <br /> Property Owner's Name: e, 10f\ <br /> . Vi z p <br /> Mailing : 9-31;1" 0Ic( 3- - VJ... �y87? P <br /> PropertyOwner's Address: <br /> Property Site Address: 5,Qn,^�,,,� City State Zip <br /> i't n't c' <br /> Contact's Telephone Number: (j 2_3E ef 4 Io <br /> • <br /> CD <br /> Contact's Email: 2rckv;S515-Q.-.1;e10../C1. C_°r^ d <br /> Legal Description of Property: 01 -oaf - C.-''-).7(- / 7.-lb " 5oc -o 01-- -0'-( v°u `D <br /> f-D N 'v <br /> Section#: 10 Town#: �j5 N Range#: f 7 W Town of: q`1,-f,L 5 = °C <br /> 5. <br /> . <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa e.* <br /> P <br /> Tax ID#(1-5 digit number;found on tax statement): 2.: <br /> 7 <br /> -2..1 <br /> T. <br /> Proposed Use of Structure/Addition: cc <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 x <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: }J <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 /> me additions,and bunkhouses.** / <br /> 6 <br /> �'s Qev'w.l`f allow 44ce ., e ,c7' p mel! <br /> 177. <br /> t , coy, V vtOV4 . No - I74j Six wt <br /> e 'im/ i'-x c 9tY/ 6e / VVeC, <br /> (.). ��,v.^ PAY' tOe Gu N n e,4_7r`C (111 <br /> . c tt ley a� %l6144 rz Fee Rec:4 Check#: <br /> v <br /> rn <br /> Date of staff site visit: 5113/2-I Initials of site visit staff: > <br /> o <br /> cn <br /> APPROVED BY LAND SERVICES OFFICIAir.... .) <br /> -DATE: 5/0601/ < <br /> UPON APPROVAL: APPNT MUST POST COPY OFni <br /> a <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° .0 ff <br /> Transcendent: - Page 1 of 4 V <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 <br /> a <br /> Ena <br /> J <br /> tt <br /> b <br />