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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c)* c <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) rm. v( <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 <br /> bQX Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 'V :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 b E <br /> Filling/Grading $150 Boathouse $500 S <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 6 <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. cip .!h^ <br /> Property Owner's Name: W 11..1-1A-(4 . 1 At3£ 4t;�-C.z z C,.., <br /> 9 <br /> .11S '242:4-242:4-Property Owner's Mailing Address: Z (4641'(4641' I.RtJrr Ni..--.; l�►'� <br /> i � C- c. I Kt x.) CS oy g <br /> City State Zip o (r1/41 <br /> Property Site Address: 26'75 b W .4 Ella 1,) Q t 4 K' O1 V AN Tk,1(L`f W I 5 4 6 3 0 p. E <br /> ii <br /> Contact's Telephone Number: 7b3--2[d-- 4 ZZ o N <br /> Contact's Email: WILLIAM - 1. laN iz- ( Gj--MR-tL -COMIlFjalPI"Ii. p <br /> Legal Description of Property: eVl4e R(Q(re Loi <br /> N <br /> Section#: I B Town#: 40 N Range#: 16 W Town of: CA k m <br /> U tJ() 0 <br /> 7' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> O <br /> Tax ID#(1-5 digit number;found on tax statement): �{es-1 ' <br /> Proposed Use of Structure/Addition: G P&-A-Ge <br /> H <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> wi d <br /> Building Contractor: Tao Sewer Installer: N/4 H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ..t <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 C� <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured Z V1 <br /> home additions,andunkhouses.** <br /> d Nee (00F CL;A o ,'t 5 S4cM <br /> Scg 4 ✓ yak% bAc <br /> #19 i)li e** Ail e-fitcc)425 lir l <br /> 01\104— man <br /> Fee Rec:3)()m <br /> yto Check#: 490/./ <br /> gI2 I aI L r <br /> Date of staff site visit: Initials �f site visit st. ��� I <br /> ' <br /> APPROVED BY LAND SERVICES OFFICIAL: 114,6g, ' /� DATE: V(�'7f h/ <br /> UPON APPROVAL: APPLICA MUST POST COPY OF 51° E 0 <br /> a. . <br /> yn tD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ow 0 <br /> Transcendent: - Page 1 of 4 °, <br /> Burnett County, WI Land UseApplication—Rev 12/2020 G iU <br /> Laserfische: - PP <br /> 7 <br /> LJ <br /> Ate'�/ <br />