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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> a <br /> b <br /> Applicant Complete All Sections Below This Line 5' N. <br /> Permit Types and Fees:(Please,check appropriate boxes) a 'U <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d —- <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 � ci <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk )( Bunkhouse $250 0 •Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 l <br /> Filling/Grading $150 Boathouse $500 <br /> in Unit(One Per Year) ° N <br /> Six Month Camping g $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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. , riNDS- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> r i <br /> Property Owner's Name: .. A S V A" VA- %�`L -- <br /> 2 <br /> Property Owner's Mailing Address: (2.0 3 "N k vi d -- be IoQ ✓�LIt ti1 k A44sr/a. $ <br /> c1 Cit State Zip $ <br /> Property Site Address:24}%b l rcr'bee 506)1 WS la/1 g•ct We-JSt pr wr Sgs13 <br /> Contact's Telephone Number: (OS('Z(o ( ' 1 411 o N p <br /> Contact's Email: NielsRode_A COV► A4AAt(4..1•cvN1 a I- <br /> r e <br /> Legal Description of Property: <br /> r, ,r <br /> 1 ' `'' - 2.- J [� t,,i* Z <br /> ) p0 00 <br /> Section#: 5 Town#: 7 O N Range#: � 5 W Town of: (--/CA I C I� f'Al �--� 0 <br /> 5' <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 0 2 3 <br /> Proposed Use of Structure/ dd'tion: L7G��i�t4 t.,`j I (ecu \K��L��C✓ cn <br /> Anticipated Start Date: 7.02..k <br /> -3 -� <br /> p (Q l � Ze Zl (Rome/Cabin;Commercial Business;Bedroom;Deck;etc.) T� i x <br /> Building Contractor:S64)G PGC.le, Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: L W <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 a,'Mops, and bunkhouses.** <br /> 14 khOt-t- Ylc34 i, Oa-eel 1 19edro0 in ' <br /> • �e 5f4-o r2 5 h re uie t►ri i'-f' i ja,-kor) per I/0P- / 9-2 co <br /> '' Fee Rec: d5Z <br /> L- . Check#: 110 -1 <br /> 5 <br /> Cri <br /> Date of staff site visit:6/?-/1 I Initials i site visit staff: a <br /> APPROVED BY LAND SERVICES OFFICIAL: .,u A //, 1 Z DATE: 6/7l <br /> Oita <br /> UPON APPROVAL: APPLICANT - UST POST COPY OF 0 <br /> iii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT fl <br /> z f <br /> r.a <br /> Transcendent: - Page 1 of 4 z N <br /> Laserfische: Burnett County, WI Land Use Application —Rev 12/2020 a ini <br /> a <br /> ro <br />