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d • <br /> c4 7 <br /> LAND USE PERMIT APPLICATION -Burnett County, WI c <br /> _ -v <br /> con tj <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> i <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4 <br /> 2 X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 p_ <br /> ,Nl <br /> Driveways/&Campground Structures $125 •WI State Statute 59.692(1v)Structures $350 0CTI° <br /> Filling/Grading $150 Boathouse $500 r <br /> in Unit(One Per Year) —.Six Month Camping g $100 Permit Extension(1 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. g <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will beGtreated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: ✓'• ' `• VJ`L _ ItrV.t•V 0 C pt LC l'(4)ST ( -u * II rAi 11i ILL) , -, <br /> n o <br /> Property Owner's Mailing Address: s`Z 6 i GRUA< V A LL Ey l Lo • N ow iti is kto • Ci 3 q g <br /> ��G`S Con City State Zip o <br /> Property Site Address: 1(b c-.) A <br /> r„ <br /> C <br /> Contact's Telephone Number: G 1�•Vi 369 • 1 b p'0 2 . . c N '' <br /> 1 ` -E (� coa. <br /> Contact's Email: TC' I1`�i2 I�I L�-W A '►�'`• v�J M o <br /> Legal Description of Property: LoT 3 CS m V to P 336 CON GOVT t'�' ? ) <br /> ! o 00 <br /> Section#: Town#: Il 0 N Range#: I S W Town of: a 1LSd^Y ° <br /> 5. <br /> a*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> C <br /> Tax ID#(1-5 digit number;found on tax statement): 01-012-Z`40 -15-1C_ OS"on Fa <br /> Proposed Use of Structure/Addition: 0 Gp GL t) SGREf1JU 90 ric -o 11000 9 ) <br /> o <br /> Anticipated Start Date: g• a-Z-1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .H -, <br /> x <br /> Building Contractor:G L\C.- € GE.I- NAI-' Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY CiJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from then:prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.**i x <br /> Q (heeA- alb Ss pot-cid <br /> :S err`h44- iS ar e { Screeoi4p,--co \�/ 1 bac wive Sidi No `� �s <br /> W !- (A) <br /> re.1'1'12, <br /> l�.� �';weid c��e d� Q <br /> iv be r eci o✓1 ` k chi 1 = Fee Rec. `D <br /> 5 ,c.P$a; lire, <br /> Check#: I 01)j,zr <br /> �y rn <br /> o <br /> Date of staff site visit: 7/2"7/?-(( Initials of.,to visit sta %. t/ Z <br /> APPROpz <br /> VED BY LAND SERVICES OFFICIAL: m .//.,,//. /DATE: (�'( <rri , <br /> rn r <br /> UPON APPROVAL: APPLICA UST POST COPY OF a m CO c 1511 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° m ^� M <br /> w p= <br /> O o <br /> Transcendent: Page 1 of 4 rn m - p 1 <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 ` •` <br /> 4 cD Y�L <br /> H <br /> lc---"-5-3 <br /> 1 <br />