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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI <br /> . Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) °. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $20 ...,CD'''' §.)j <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> C51 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r9 <br /> Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r- rT <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> rn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 4dr r Al (a s` ,r C I z �' <br /> Property Owner's Mailing Address: 4543 R he RK. �G of o✓ 1�l /. i c537 . o �' <br /> o J <br /> bur; <br /> �� ] St to Zip <br /> Properly Site Address: gm Dear/x(14 '' l"t,�t bAri ru W ( sq 30 E' <br /> Contact's Telephone Number: 6(2 -3d S. 14 2( Z o N <br /> CD <br /> Contact's Email: mQrkniCatSi k• Z 4� gi t. C d'),1 d <br /> Legal Description of Property: D ee rp fli ail 4" ids S)f 2,53 ( , /JJ <br /> I N -o <br /> Section#: Town#: N Range#: W Town of: ,aaek5ort <br /> rig <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system properlyPage.* <br /> Tax ID#(l-5 digit number; found on tax statement): 6 7q4- <br /> Proposed Use of Structure/Addition: Carl , 14 ' g Wc4 �r 1/ ID , <br /> .� ti <br /> Anticipated Start Date: �Uli 1202( (Home/Cabin; I,mmercial"usin• .;Bed porn;Deck:etc.) G o �e <br /> CI <br /> Building Contractor: Ma lek• /MC4$I/Y1 Sewer Installer: n D �r Ve L�4� <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 1/DC Inspector to determine if a permit is tteeded,from them prior to <br /> .'1NY construction taking place,for any dwellings, dwelling additions,manufactured homes.manufactured z <br /> home additions,and bunt souses.** (� x 3 <br /> i t Oc.A f CVM.l'ei 04 o- I C� <br /> 00 e� e� r Y5 , <br /> -� Fee Rec: 4 3 a D <br /> Check#: (15.50 <br /> 5/1191a—� <br /> Date of staff site visit: Initials o <br /> .ite vii t staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: /� 5/p0! v " 'O Uu <br /> UPON APPROVAL: APPLICAN UST POST COPY OF 43 - l` <br /> X-6 ..--- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . �, <br /> Transcendent: - Page 1 of 4 <br /> iliiii <br /> Burnett County, WI Land Use Application —Rev 12/2020 < --- <br /> Laserfische: - r <br /> d <br /> cil <br /> ) <br />