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LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> N N <br /> Applicant Complete All Sections Below This Line <br /> Co i <br /> Permit Types and Fees:(Please,check appropriate boxes) °- W <br /> A ,y <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 B. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150I- <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 et- 8, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 r\ <br /> � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° e <br /> Filling/Grading $150 Boathouse $500 r r <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 ilk <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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. CD <br /> Property Owner's Name: GO- --� d- K�jI It,/ <br /> 0 I r(0 C// .„ - o <br /> Property Owner's Mailing Address: 2-(J L'i b Lj -1-11'101 CatAvl CIAS&Ik ►'//t/ (.952)-7 o <br /> a. <br /> �^ �>°i�1�,F��City�'� State Zip <br /> Property Site Address: a p I �� t/, xt 't 'Rot t' 1 Wt.- _ i V) <br /> Contact's Telephone Number: <br /> (O la--15147 -oI.:,vi . o E l, F <br /> Contact's Email: l V( rie, foJicU rcV o <br /> Legal Description of Property: 451 CW)VC (P Te2i/ 1 COtov O I I" - 4160301-{ i <br /> N 'v <br /> Section#: Town#: N Range#: W Town of: °_ °0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa8e.* <br /> d <br /> �1 <br /> Tax ID#(1-5 digit number; found on tax statement): 3 yga 5 =- <br /> Proposed Use of Structure/Addition: Q,r-a. <br /> Anticipated Start Date: 1-)- Z OZ I u (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> 1 <br /> -71 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: . ..p <br /> **The applicant needs to cont �1 their UDC Inspector to determine if a permit is needed from them prior' j t—' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufacture*,, z (j) <br /> home additions,and bunkhouses.** <br /> O eek aL 5e4- o1s <br /> 6 Nth ccvr kafrai Ilaboni 1 <br /> Fee Rec: 15e) <br /> / 2 1 j / e <br /> Check#: —0L'5 <br /> Date of staff site visit: &17/ 2-1 Initials o site visit staff:tT1' a <br /> APPROVED BY LAND SERVICES OFFICIAL: t j/ ``/j'//1 DATE b/' /)-1 - r <br /> w <br /> liffl <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> <.c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT '• y C i [tut <br /> 0 0 <br /> Transcendent: - Page 1 of 4 • <br /> m c`; <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 „3 <br />