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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <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 i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 4: \` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 a IIII <br /> r' <br /> Filling/Grading $150 Boathouse $500 r 04. <br /> 0 <br /> Six Month Camping Unit(One Per Year) .$100_ Permit Extension(l Year Extension-Allowed Once) $100 ) <br /> v' <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 4 v <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. v <br /> ro ,s <br /> 0,Multia <br /> E. <br /> Property Owner's Name: t V O Z i '-f & MP PY?Df111%.S f LLL+ DBA - -z-'j"�`� o `.rt <br /> Property Owner's Mailing Address: P D• 2OXX Feld Bl l i-4 V i 614430 o <br /> Property Ac2g l�Uu I y /k� li � �ity State Zip b n <br /> Site Address: y <br /> 6/4/4°5 4 a <br /> Contact's Telephone Number: 1 t S• I • a-ii o <br /> Contact's Email: MAIN i & Ninc11'tAMP oQ Th 6. tom al re <br /> re <br /> A�h�� A,615re <br /> Legal Description of Property: ' v. f Z 7O,AD , 0-6-14-0-fie kg '4 5C'f <br /> 1.0414(4e OL5% <br /> -�• o vo <br /> Section#: a! Town#: t N Range#: 5W Town of: J/kms a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* G <br /> Tax ID#(1-5 digit number;found on tax statement): 6 1442 5. v <br /> Proposed Use of Structure/Addition: "' <br /> �J, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: y �A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY1731 3 ..E. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicitoi acetic to c:ortieect chew i tit itt,+pccitii'10 determine if a permit b nec'actl jraliii Melia prior to <br /> .4NY construction taking place for any dwellings,dwelling additions,manufactured hones,manufactured <br /> home additions,and bunkhouses.** z <br /> v1iee' -- cJ( e4 <br /> lOg'CLICh <br /> . &G <br /> 0C* k-or kKeeklcim he,b;-1- 0/1 <br /> g Fee Rec:f l QQ f <br /> A Check#: (.0 <br /> rYi <br /> Date of staff site visit: 7/131 ( Initials a site visit staff: 10 DATE:7/1q/21 <br /> APPROVED BY LAND SERVICES OFFICIAL: m <br /> co <br /> rn. <br /> UPON APPROVAL: APPLICA // UST POST COPY OF z co �`� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' 2 � 8 <br /> 0 c ca CI <br /> NJ <br /> Transcendent: - Page 1 of 4 ,'„ <4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 '. g !-?-� <br /> i <br />