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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line °. c <br /> Permit Types and Fees:(Please,check appropriate boxes) -.6,° U1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: Nj <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v�"� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 9.3 `; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Ol r, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° 6' 1 <br /> Filling/Grading $150 Boathouse $500 C- <br /> a 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CA <br /> *NOTE:After-the-fact permits(permit aquired 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 'A { r 0 <br /> Property Owner's Name: re_c t - k y y (-,3„..y\( ek 3 e.\,,VK .-.\'2 e o <br /> 3 ! O <br /> Property Owner's Mailing Address:602. S ho rQt&AecA Dr Un C\ .2d'. Cie Cv„vajr,r A, L . o <br /> • <br /> City State Zip $ 41 <br /> Property Site Address: /5 LI L t v\ e e\h 5 i 1 vJ jc Sit 1' VI I 5413W-5 I: <br /> Contact's Telephone Number: (0 5.1 - 34 t - cik LI, L tJ o <br /> CDCD <br /> Contact's Email: C\rt, u,,l-i• 1.c_ Y\ e e h4 LY r j 11rt\V.... n e o ; <br /> FD <br /> Legal Description of Property: if 6 a 2- J _ �. S�r 5. <br /> Section#: 3j Town#: #0 N Range#: /6 W Town of: no,v.,1e,�a ., <br /> IX k <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): I t-}117 . <br /> Proposed Use of Structure/GAdd' srtion: , b "' <br /> Anticipated Start Date: //// Z/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C� V X <br /> Building Contractor: <br /> 5e_ � Sewer Installer: � a.^.e. <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 <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** <br /> 0 filet4- ei.it Se 4'bcc it_3 <br /> 0 (V&A— kyr (1,44,4n it4b,',6,41.0^ <br /> 7, <br /> Fee Rec: —CR <br /> Check#: 9 <br /> 8131124 L <br /> Date of staff site visit: Initials of to visit taf z <br /> Ai <br /> APPROVED BY LAND SERVICES OFFICIAL: V•/ DATE:9 I/'02/ '_=� <br /> i [Filo <br /> UPON APPROVAL: APPLICAN '7 UST POST COPY OF .. <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 1 Fill <br /> Transcendent: - Page 1 of 4 4) <br /> -, <br /> Laserfische: - <br /> Burnett County, WI Land Use Application—Rev 12/2020 ---4 <br />