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CA °Z1 <br /> LAND USE PERMIT APPLICATION — Burnett County, WI i`°E. <br /> b <br /> N N <br /> Applicant Complete All Sections Below This Line $ CD ;r <br /> Pe mr it Types and Fees:(Please,check appropriate boxes) ;) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 - VJ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V .-G <br /> )(1. <br /> Accessory Structure(Garage,Shed,etc.) `$150 Addition/Alteration to Accessory Structure $150 -1 2 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 21 <br /> 21 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 — <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. R. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. CD fa,, <br /> M 1_ �\ 6 rm. <br /> Property Owner's Name: `, `a.0 G se: G WE. .In er z <br /> ` MN` q � ° <br /> Property Owner's Mailing Address: 1029 �O e la,w,L, el std t. Ssi1 0 <br /> Not'�kh CR pp w <br /> Property Site Address: Z� 8 3 U. 4 c$ F �GgCitx $�>tiQ.e p�NI ' z <br /> Contact's Telephone Number: (p$ 1 2.14 " 46-4 c s g�3 —sem' , <br /> — <br /> 1' ( CDQ. <br /> Contact's Email: Lk.O S Daces.er G Imo: \ . G O M d <br /> Legal Description of Property: D O G * 32.`1 9,z S <br /> N o <br /> Section#: 6 Town#: .3% N Range#: { $ W Town of: I...ct-c6 I,t"lr'Sc.. 0 a <br /> . <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t7 <br /> Tax ID#(1-5 digit number; found on tax statement): q <br /> 3. <br /> Proposed Use of Structure/Addition: Pb't fc, 8 c r t' <br /> Anticipated Start Date: (Home/Cabin;;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: S1neC M.MI., 64,+, LIQrS Sewer Installer: r <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 • i <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouse ** x <br /> 1 Ie�-h (kit <br /> Se c - tt'�✓1 <br /> N - j kita' 4ba'Ta11 <br /> hoer 4. AT) 5e p c dr I'e ti <br /> ect <br /> g <br /> c� • ar , s .,pie Iv- .I °°otelC e SC C tS t styo tri ' r x Fee Rec. /� <br /> o r�- needs •►C�$SSC� GIrR�Z ',S o Check#: CW12 <br /> DSP 9 m <br /> Date of staff site visit: 7124 Initials of ite visit staff. <br /> , ' ' 'Ai ,„ ' ....C2J <br /> APPROVED BY LAND SERVICES OFFICIAL: ' , /i ' DATE: N.342 p <br /> UPON APPROVAL: APPLICANT r ST POST COPY OF 1 W c lifi <br /> APPLICATION IN PLAIN SIGHT 2. r <br /> SIGNED PERMIT S. („i, <br /> N Ril <br /> Transcendent: - Page 1 of 4 s N <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 <br /> .711 <br /> u, <br /> a {. <br />