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• LAND USE PERMIT APPLICATION—Burnett County, WI a " <br /> b <br /> Applicant Complete All Sections Below This Line g <br /> CD i <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 b 1 <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 /> f <br /> Accessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 <br /> X Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G1 <br /> Driveways/&Campground Structures $125_ WI State Statute 59.692(ly)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 t- <br /> 2.0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> cn <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. , o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 <br /> ILL M- C /� A r <br /> Property Owner's Name: �'l P '"t y HES S z <br /> Property Owner's Mailing Address: qo F iv/u7791ty Sr 640 eu7/QE co/ 59g03 0 <br /> J / / n City State Zip b p <br /> Property Site Address: `7 6 '70 Ll9k4" c / 9.0 6Ar.)6VIL)/ W l 64.030 a: <br /> 7 I 3 <br /> Contact's Telephone Number: 15- 555q- 3 33 0 o <br /> L N <br /> Contact's Email: J rri j he r S 4-904 a)q m lLr-1 - CGVN7 \ <br /> J r7 �J p _ <br /> Legal Description of Property: LD II / OE . v = - P &o-! 1 I ) (A)_17 6 �'1, <br /> Ell 1 o ' <br /> Section#:,a,,,lt Town#: q i N Range#: l S W Town of: tio i SS <br /> 5' ilti <br /> *Attach additional page if needed for lengthy description OR attach a copy <br /> of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): C9 /5 4710 <br /> Proposed Use of Structur /Addition: S/ G'-PS (/9-CC'ES'S %O Z-49126"") r, <br /> tsl <br /> Anticipated Start Date: r o ', <br /> ) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor:AUS%/N `r9KE An,O,S'�PNV4 Sewer Installer: V <br /> o <br /> .� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: j., Ch <br /> *The applicant needs to contact their CDC Inspector to determine([a permit is needed front them prior to <br /> ANY construction taking place tar any dwellings,dwelling additions,manufactured homes,tnantl f ieluresl z <br /> home additions,and bunkhouses."" <br /> • 0/1(51 I S e+ o54=‘;(5 <br /> 0 1u5P' ; 1+ ,- tce or Oilier, eroS, '4 <br /> 1 Ce.14* <br /> obi <br /> 9 <br /> FeeRec:l'�Q5� <br /> `' <br /> � <br /> j d <br /> Date of staff site visit:5"C/ f�I Initials of site vi t staf Check#: a V 5 j <br /> t ril <br /> z _ __ <br /> APPROVED BY LAND SERVICES OFFICIAL: / /j DATE:6'0/2 < '' <br /> / <br /> ` run I �'�� <br /> UPON APPROVAL: APPLICA T / T POST COPY OF n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z _ <br /> r n <br /> Guy <br /> �C <br /> Transcendent: - Page 1 of 4 a C NJ <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 12/2020 < a'` o <br /> o 3 Uuu <br /> v, <br />