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• • LAND USE PERMIT APPLICATION–Burnett County, WI b <br /> a 2. <br /> s <br /> Applicant Complete All Sections Below This Line I• a -N,, <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 A\ ' <br /> .0.,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 5 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 . O • <br /> Filling/Grading $150 Boathouse $500 r, <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> I <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a• <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. • <br /> $• v <br /> t <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r +• <br /> Property Owner's Name: N)00 1-i NOP V -1 (es 1.1- W( D 3A LA-zy /k AID 9. c <br /> m o ta <br /> Property Owner's Mailing Address: P D "&x, 1 17A-Ni Dtt t.�.4 V i 61430 ,- 1,, <br /> (, a11� Jiiity State Zip v n ly <br /> Property Site Address: b g e eDtt f p ti AD F. <br /> Contact's Telephone Number: T• j 0 7-7 6 P�t �I o <br /> Contact's Email: Irl t nineilll C+A►PIa2UCCili;S. eoP1 4,. a j <br /> .14095 6 <br /> Legal Description of Property: �()4" , i ��, a )/�i UE'1' I file FJ V G�e I4 I/ =' <br /> Section#: c2 a Town#: 15N Range#: � W Town of: ,/3t t w <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> FA <br /> Tax ID#(1-5 digit number;found on tax statement): J 1 ff. <br /> Proposed Use of Structure/Addition: liG� 4 s t4 t) �iQ,E- ST1 A( cn <br /> Anticipated Start Date: r � o <br /> (Home/Cabin;Cvnr+ercial Business:Bedroanr;Deck;etc.) , <br /> e <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y % v.-t' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: — <br /> **T/, ,Ti :to i o,,,,,,io t'!}ifol ,heti't,Dt inspector to determine if a permit is needed from them prior to 4 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured ,Z ver <br /> home additions and bunkhouses." <br /> Meek 4 i 5e et cits -�'�''I <br /> sited A.+ cfipf Ili-0114n <br /> Fcc Rec: 4254;a <br /> 71 <br /> g. Check#: 575, <br /> 6M <br /> Date of staff site visit: 117/?t Initials of site visit staff: 1••' <br /> APPROVED BY LAND SERVICES OFFICIAL:14 DATE:60/2 ,T=.. / <br /> ra w (� <br /> UPON APPROVAL: APPLICAN UST POST COPY OF <br /> tol <br /> II <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 7 ? Guy <br /> .t ° c) c.71 <br /> Transcendent: - Page 1 of 4 En 3 " Q <br /> Laserfisehe: - Burnett County,WI Land Use Application–Rev 12/2020 1 a•` Na <br /> Kll <br /> rp <br /> g L�--"-- ) <br />