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LAND USE PERMIT APPLICATION--Burnett County, WI c <br /> Applicant Complete All Sections Below This Line g c <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d 0 <br /> ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .6-- <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `` , <br /> � <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 °e <br /> Filling/Grading $150 Boathouse $500 r+ V' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> rn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: NO Q1' � (Pt J W VOD �K-I tes n e. Dgk 1 A l z i <br /> 0 <br /> Property Owner's Mailing Address: P D "eUx, 17/kI P U IN \Jv 1 611-00 o OlieIt <br /> Property b o + l�U/.(1�III /k� � f .ty State Zip . " <br /> Site Address: °i <br /> 1 'j• 1I - 071 f " i <br /> Contact's Telephone Number: `�� ��l o C <br /> ,�^ t nlo�.fo& ?I2oQ Tii . OM 53 a <br /> Contact's Email: MAI1 i� <br /> rb <br /> Legal Description of Property: X04- I e.3,:ft-A.)615 J. fa vg. 9A! LL',4-oir me IJ.i I/i},jC lrl4 DR%0644 pp <br /> N ua V� <br /> Section#: a I Town#: 40 N Range#: 15 W Town of .3k ki E. <br /> 0 <br /> *Attach additional page if needed,for lengthy description OR attach a copy of the deed OR attach tax system property page.* C <br /> Tax ID#(1-5 digit number;found on tax statement): 51+4-2 5. <br /> Proposed Use of Structure/Addition: DLGIL 'Slick rn <br /> Anticipated Start Date: (Home/Cabin:Commercial Business:Bedroom:Deck etc.) i IS <br /> Building Contractor: Sewer Installer: r <br /> H l '' <br /> LA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r -- <br /> **The <br /> **The etl'i)2icfirie l£c'e{y ti)CindiE1C1 112C.E'LL1L 112SJh:LiUPi'ii)fieitii1IHEC if 11 permit 1'siietAiel1 fi'olli Iiien!prlf)r'111 zlV <br /> 4 NI'construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home addition0s,and bunk uses.*';� / 70d s► fir-,1-4,r lives leig,be 1 <br /> go <br /> g Fee Rec: i,��� <br /> c. <br /> Check#: /31 <br /> 6/17( �! tLYI <br /> — <br /> Date of staff site visit: Initials o site sit staff: <br /> / i <br /> APPROVED BY LAND SERVICES OFFICIAL•g % DATE:616,91?' ��OJ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF .,-. <br /> 4 SD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 H - Nil <br /> - <br /> • yn <br /> Transcendent: - Page 1 of 4 0 �.� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 3 s< r. , Q <br /> LTJ <br />