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. LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) a c...11 <br /> o <br /> X Dwelling/Principal Structure $301:: Addition/Alteration to Dwelling/Principal Structure $200 opGO <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `. ilka <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 2 j <br /> G1 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r- ^i- i <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year 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. t <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. - L. <br /> , <br /> 3 <br /> Property Owner's Name: 747 /` (7i y,c7 -/ Acv)-77v"- co cA <br /> Property Owner's Mailing Address: '"& -/ x6-ti G()K81 A) -5S''Y.?? $ ._ <br /> Oe._ <br /> / City State Zip <br /> Property Site Address: b', /,(7 D4-0.5 ( e G1e 65 e - ,jt�j�j 3 �. <br /> ,ziz, O <br /> Contact's Telephone Number: / 6(.2- 3 63 — /2pG, o op <br /> lO <br /> a � <br /> Contact's Email: ZO' //A.J / �B' ()-:--F/14-; / , CO/is <br /> Legal Description of Property: T V <br /> o vN av <br /> Section#: 7, `Town#: 9 N Range#: / W Town of: e,e,r/fl&) <br /> a` <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax systempropertyPage.* <br /> d <br /> 7 <br /> Tax ID#(1-5 digit number; found on tax statement): 12_0 Zc--- <br /> Proposed Use of Structure/Addition: 7ep'jg, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ox <br /> Building Contractor: aiC7 <br /> 6-1/S7 Sewer Installer: �(�� / �ef <br /> -} ! OWN.. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMIMIE.NTS/CONDITIONS ONLY C <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 ( lam <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z �l ' <br /> home add' 'ons and bunkhouse .** p:,d (he Ott Se -1 c S <br /> e. 0..vet(1 nal -iv exceeti 2 per N?I ~OS <br /> ©CoaJ'lfe i lee perin*i iT bei�f Kep+ 04 1o"Aau,P� <br /> coo Golfe( <br /> , �/ Ca;JJ u$eci lJ = Fee Rec: 3(�Q� <br /> �-fJ JJ�� Check#: c23/01g, <br /> 3 /3I la-I1---Date of staff site visit: Initials of s''e visit aff: <br /> I- V t <br /> / w <br /> APPROVED BY LAND SERVICES OFFICIAL:aP,! ,/,/,' ,.-/P"/ DATE:9 11l �I < . <br /> 7-7 g 0111 <br /> UPON APPROVAL: APPLICAN ST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 a o o <br /> N <br /> Transcendent: - / Page 1 of 4 ',. N <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 - 2 <br /> N <br /> cn <br /> a <br /> 3 <br />