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LAND USE PERMIT APPLICATION — Burnett County, WI a @ <br /> Applicant Complete All Sections Below This Line 6' <br /> CD i <br /> Permit Types and Fees:(Please,check appropriate boxes) n' JL)..) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 lie. 01 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .7 <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 C \ gO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 5) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 g <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 '-, <br /> vp <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 /> 1 <br /> Property Owner's Name: 7)..._cCkliN i\ T� 6� z <br /> 5H5 CAI ` __tc1 (, bI tlLath � �6o p 6— <br /> I <br /> Property Owner's Mailing Address `_ ' ` <br /> if-Mc--) C....\--\' P 1 1� c�V�Ci,1 LCTy W� S•Je�c ` � n V <br /> PropertySite Address: i n ` I. N <br /> 77 Cs <br /> Contact's Telephone Number: -71 � -O�� � <br /> Contact's Email: —c ` c c?(s s, &[ i c,t_h c)tow) a <br /> CD <br /> n of <br /> d <br /> V o 1 �/ n <br /> Legal DescriptioProperty:` �L- 1 W NE-O e U 3ge o 'XV57� r'uc <br /> co 1-two N <br /> Section#:9.1 Town#: 7jg N Range#: 1 W Town of: e, <br /> on <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax m property page.* C7 <br /> Tax ID#(1-5 digit number;found on tax statement): 3`"I o 0' <br /> L4 <br /> Proposedc-Use of Structure/Addition: e - x <br /> Anticipated Start Date: LO I ' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> ....!/ e <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 W <br /> home additions,'and bunkhouses.** I <br /> 0 M ee+- ail 5e4-bcir ks <br /> 0 Noi-- r �,, cc,n h a,�J.' ,4'v 71 <br /> Fee Rec: IVo <br /> 6/71 ).i L <br /> _� Check#: <br /> Date of staff site visit: 9- ) Initials of ite vis' staf • z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> 6kV <br /> n a C. <br /> UPON APPROVAL: APPLICANT' UST POST COPY OF vw g g <br /> cz <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z c l N <br /> Transcendent: - Page 1 of 4 '° j• r.) <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 < 3 <br /> tri <br /> o cA <br /> `= <br /> a <br /> 3 <br />