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Authentisign ID:E930F628-FFB4-4429-AB36-8316BC7F0517 <br /> LAND USE PERMIT APPLICATION — Burnett County, WI E. <br /> __,.._ Applicant Complete All Sections Below This Line o' y <br /> ti...) <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> C7 03 <br /> 4.--.bwel I i ng/Pri ncipal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200_ 92. K) <br /> Commercial/Industrial Structure <br /> $300 Addition/Alteration to Commercial/Industrial Structure $200 11. <br /> (T A..)_ Accessory Structure(Garage,Shed,etc.) $150 Addition/Aiterationto Accessory Structure $150 �0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 S. i <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year 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. rn <br /> z. <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. 1 <br /> 3 <br /> Property Owner's Name: DA N% ()f(rt((,Q �C)u{�t� , ? z <br /> 0 <br /> Property Owner's Mailing Address: 51 I7 2N chi-A((. )/j A u.1 to t 4',g /1 yt 5-512 if o` ,, <br /> , , ity State Zip , %Property Site Address: ._ - ' 415.0 t <br /> i c.A.hS 30 17. <br /> K <br /> Contact's Telephone Number: /It Z Ll j q - LI/; ' o <br /> Contact's Email: t a o <br /> I / ` - . �t <br /> Legal Description of Property: 1(�k S C60, .J q ''4 L1(�( Gita ( - (, <br /> N e <br /> Section#: ,. Town#: tiO N Range#: ko W Town of: Oaid�c.(�C a a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): 1?55--7 n. <br /> Proposed Use of Structure/Addition: q Iory`p <br /> Anticipated Start Date: — (Home/Cabin;(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> F <br /> BuildingContractor: 5C-617011,(1-1,L., ___ o <br /> _ Sewer Installer: �/�(),��/'tfJ <br /> • A'BELOW THIS LINE FOR LAND SERV _ S STAFF COMM NT COND[T1O' ON V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 03 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to JI <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z v 1 <br /> home additions,and bunkhouses.** ( 54�,'.7,^'� �,1)>DvaltiO } ekceed� 3 bertrcx' s ptr <br /> 1 t a!I s64-bet <br /> (��J t(,' v jJ- S e a.,� It heb k -I <br /> 1� �/�" e (���wl�Ce. 1/ T; i rl b f V. Fee Rec: 3O– <br /> 1b V 5e s;y� -C-e n v .0 1'S re e9iet (� U' Check#: <br /> 11 56,9 <br /> tc <br /> Date of staff site visit: / Initials o site visi staff: Lz . ...s.__J=D <br /> 11 <br /> APPROVED BY LAND SERVICES OFFICIAL:101"r/ // /iii DATE: ✓/�` /2 < a <br /> oz D n <br /> UPON APPROVAL: APPLICA a MUST POST COPY OF RI ( vl <br /> *10 C [Fa <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 0 <br /> N <br /> s3 c4 <br /> Transcendent: Page 1 of 4 x <br /> Laserfische: BurnettOW <br /> County, WI Land Use Application — Rev 12/2020 (C-15-2) <br /> z. <br />