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LAND USE PERMIT APPLICATION - Burnett County, WI c- g <br /> b <br /> Applicant Complete All Sections Below This Line 5' C <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> VJ <br /> Dwelling/Principal Structure $300 y Addition/Alteration to Dwelling/Principal Structure $200 d i9 6' <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 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 N F4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° r <br /> Filling/Grading $150 Boathouse $500 r "' • <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(1 Year Extension-Allowed Once) $100 P <br /> cA <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ET <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro i <br /> Ilk\ <br /> Property Owner's Name: RIO J 2 0 4\e-5 ° z r% <br /> Property Owner's Mailing Address: l 71 Araet',jo,1 Or Ockobvry uff 521$30 S <br /> City / State Zip n. <br /> Property Site Address: a1-$l 79 At1derSO Dr Do,-hbvr y Lam- Stig36 57 <br /> E <br /> Contact's Telephone Number: o2‘8'-3111 - SLI e -z o r <br /> CD <br /> CD <br /> Contact's Email: 1'6,hPcJ\\e5 ,5 7 6. �:r, , co m d <br /> Legal Description of Property: 1..01- C_5 in l' I cc V I 2 l O8 CO-1 " IS-65 t• <br /> N b <br /> Section#: 4 Town#: 40 N Range#: 1 -7 W Town of: Ur\C o R 0. °c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number; found on tax statement): ,-,j63„9- ' <br /> Proposed Use of Structure/Addition:1 - Le-\e-CA1'a ,. '10, 4 i 1 10 n, cn <br /> Anticipated Start Date: -.J V r\c 7 az,a_\ (Home/Cabin, ommercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: k€01". C�l 09)\R-5. Sewer Installer: �- a <br /> •-3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 <br /> home additions,and bunkhouses.** <br /> Cf b <br /> Dvj6 (:^^``1� 11wwt� �t t rcein <br /> op V5e, 'I4 �efice or mer eroV al C,c"1+fol Un-� I <br /> ve5e--c (biA/5 baton <br /> s Fee Rec;3, <br /> A <br /> Check#: 5-72/. - <br /> GPLib" Iorn <br /> Date of staff site visit: Initials of site visit staff: I <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: / m <br /> ���. �.I ���� DATE: � /5 � < i <br /> fi <br /> UPON APPROVAL: APPLICA � MUST POST COPY OF a in 1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° s l 1 g <br /> pa c <br /> Transcendent: Page 1 of 4 co N C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < g <br /> 0 3 ' <br /> rn <br /> ( <br /> S. <br /> i <br />