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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 6' <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d v\ <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 g <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `Jp� �\ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 W <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G,- d <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(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. = <br /> rp <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. t <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> Property Owner's Name: V T of f r`e y IQ_ $ �'>'! <br /> ;vr /e <br /> e/ zCP <br /> 0 <br /> Property Owner's Mailing Address: .2 ,.k /it* ,1v' 5'� J'74/149,0/S, /1V1/ SSWg o. „� <br /> Property Site Address: 7�O Ae<t l/Aiy ko4 �i/e Zsj 'r1 �/ State Zip <br /> ! 0 n __z- <br /> r l <br /> Contact's Telephone Number: cl/2 - 2P...2 /- Ssy \ o• F, rt <br /> v / CD <br /> La. <br /> Email: JC ffS�lr,'.i/`C l'd' COQc.�J/� .fc/ d <br /> Legal Description of Property: in/2 Cs�1//,3 P/13 See/•p4 PI /dadie Of live lSi <br /> 9 N -e <br /> Section#: Town#: 3 r N Range d: /$- W Town of: GR # //'d A o °° <br /> . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement):// 0 2 -O/7th-- 2 - Yg - �`S - e29- <br /> Proposed Use of Structure/Addition: fr./00->i I /6,4 ,•e, <br /> Anticipated Start Date: 1 y <br /> p �-J- p�/ (Home/Cabin;Commercial Business;Bedroom; etc.J � ---Q1 <br /> 1 �' <br /> Building Contractor: /Il y self Sewer Installer: & / d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 \o • <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S-% <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to , 0ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z .� <br /> home additions,and bunkhouses.** a (� <br /> I t o II,to m ,,,L,/,, '4,6,,, .„ r e_714),J p eite .ovv d <br /> D ' (e a t�'4 4c,e, I <br /> h V G U e f^�/hS N �iV�! x Fee Rec: o�L7� <br /> 3 OwaII i1 no4- d� e 3 b P`Q" 541V- 21- ; Li( <br /> Check#:35Y1_4_, <br /> /.'. <br /> Date of staff site visit: y if -7.0 Z/ Initials of site visit staff: Ili- <br /> . <br /> / <br /> J D <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: $/Z3 f 7o ,/ • r <br /> C. <br /> Eiji <br /> u <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF c c 0 <br /> . 0 . wgifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT — <br /> Transcendent: - Page 1 of 4 a,` r-'' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 . a <br /> K <br />