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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5. <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) "' <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 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 `; <br /> �/ Deck/Stairs/ ati /Retaining Wall/Sidewalk Bunkhouse $250 $5.1 <br /> L_ <br /> /� Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r- 1.) <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 k <br /> *NOTE: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. F7 ' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: )U\\G.01‘,Z 'tT L.) Nt.," x"\r‘Th z <br /> c <br /> -� <br /> ( \Property Owner's Mailing Address: ,2."3 'i c 1 ,-\c.h - 11/44\S,....,N (. D S+i r t' _i- o <br /> i City State Zip a. <br /> Property Site Address: 1---1 2. t S t r..t t S (�.L Int-,C� (�/+r) `IL. <br /> 4 I <br /> Contact's Telephone Number: (.‘,'1 -u .Z -f 2—- (4-`} ' o g <br /> CD <br /> Contact's Email: 51'LA t r1 I ?'3e /(,,°t'_ ca tv 1 M.d <br /> ILD 0 <br /> Legal Description of Property: I ,\ S 4'). a...a;ae; a. 4 -1-1e:., ,i C. ,a 4' r .. <br /> N b <br /> Section#: ?, .' Town#: ' , N Range#: V'1 W Town of: 0 l.. (VI P\. I ?)-.=-:-r`etr C i''n) ° an <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system propertyPa page.* <br /> C) <br /> EZ- <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: v P':; A-)rc \, p c,;' 0 ;Z1 C4 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> d <br /> Building Contractor: Sewer Installer: s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: —, �1 <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 z <br /> home additions,and bunkhouses.** <br /> Dater ,j1 5ekl 446 <br /> 0 Cpm exs 4-o be Co illletitai 40 5efi9L AsAPAAJ <br /> okk- cto 4-4.41csi. <br /> z Fee Rec: / i-' <br /> y Check#: //Q0 <br /> o <br /> Date of staff site visit:5/P-5/P-I Initials of to visit aff: RL m <br /> L <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: `610 - Q.Q gill <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . L I <br /> 0. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' .Q = <br /> INS <br /> Transcendent: - Page 1 of 4 ' a <br /> Burnett County, WI Land Use Application—Rev 12/2020 -� <br /> Laserfische: - <br /> a <br /> E <br /> b <br />