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• <br /> LAND USE PERMIT APPLICATION—Burnett County, WI c b <br /> w• <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 ;c2-- 0 <br /> r. <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 g q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 XL� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 a Ali: <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 P <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. I <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. $ _1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> m A <br /> Property Owner's Name: NDtQ:f(4 NOP I"e (es: We- DgA IAy z .i <br /> / rr�� o ` <br /> 6 <br /> Property Owner's Mailing Address: P D a0X, (p Pi-n1 P U 64 VI J OM g <br /> f _City State Zip 1:1 � <br /> Property Site Address: b I iUu I /kD \vW �C.. <br /> E. <br /> S 6/4 O5 ri <br /> Contact's Telephone Number: it • I • a 71 0 <br /> Contact's Email: MAIN t 01eTH OAw1P OCC Io. w d r, <br /> �a>q 5 d t y, 06 it <br /> Cb <br /> Legal Description of Property: �()'�" � �I�/I J. 12 Pg.p�f73 (•,G���+'o(-�e kg,I/t}c. ��t' <br /> Section#: a I Town#: 1+0 N Range#: /rj W Town of: 2/k ,,i..1 ? 0 <br /> a' 1 <br /> *Attach additional page ifneeded or lengthy description OR attach a copyofthe deed OR attach tax system roe page.** no <br /> P g .T S Y P ��!! Y property i'tJ'P S C. <br /> Tax ID#(1-5 digit number;found on tax statement): J.0-14-2 ff. 1 <br /> Proposed Use of Structure/Addition: b L C4 fit& I PAX 1-5=x106 r" <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck etc.) W <br /> Building Contractor: Sewer Installer: �'1 <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The tip17lic`if izefd' i(1 CiiilitiCi'flew L•LYC inspector,Yr defcrotiae if a pertiul i�s needed/room Mem prior to <br /> .4NY construction taking place for any dwellings,dowelling additions,manufactured homes,manufactured 'z <br /> home additions,and bunkhouses.**al; all( <br /> �be,c.GY`� <br /> 0 e91 (- 11 <br /> 41) na I-4-of kim41 -tli <br /> Fee Rec:/43 <br /> a. <br /> Check#:730 <br /> tli <br /> Date of staff site visit:6 /17/? / I 'tials of e visit staff: H <br /> APPROVED BY LAND SERVICES OFFICIAL: )r-s.. DATE: �l1 /?T •UPON APPROVAL: APPLICANPOST COPY OF a cHit <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT R 5252 <br /> Transcendent: - Page 1 of 4 g w s1,...., <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < 3 t"' /:: <br /> 2 YwY <br /> U _ <br />