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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 6 <br /> co I <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> �/ <br /> Dwelling/Principal Structure $300 7(Addition/Alteration to Dwelling/Principal Structure $200 K <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `� .6'...),) <br /> n <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,�'� g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 P <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° D <br /> Filling/Grading $150 Boathouse $500 0 k) <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 k <br /> v) <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <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 /> !J� t L 9 - <br /> Property Owner's Name: � !v �>^ �3 P i7 z <br /> P 1 <br /> Property Owner's Mailing Address: 6.5-9-2 c c C //O a J v0f'i6 0 40 —5-3/00 °o <br /> / /� City / State Zip <br /> 653%9 <br /> Property Site Address: CCC. t�,�\ (�/c; 40,-S/ w f 5e/ 3 c) <br /> Contact's Telephone Number: / 15-:-- 771 — 0017 / o 7 <br /> Contact's Email: 6 o.tJ e iScn 2S ?c kJ i✓C , et <br /> J '� Cgs-V*7 <n�d) '� <br /> Legal Description of Property:-St< J1 4 410 R316 Pa. AJw j iv (i 34/Res .14 A1J7 / psi <br /> f N -o <br /> Section#: /V Town#: 410 N Range#: I6 W Town of: OgiteLQ n El °_ °0 <br /> 5' <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * <br /> P g f f S Y PnY P P tYP S p <br /> Tax ID#(1-5 digit number; found on tax statement): / 3 ac-S 7 <br /> Proposed Use of Structure/Addition: Veld,c :'5l"y deck=InA4 Ia <br /> k,`n C vel - /��c/ v v td- ..*:› c' <br /> Anticipated Start Date: 0,:t " f Vc�J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C x <br /> Building Contractor: / f.b e Je'tS eq Sewer Installer: . <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -, 2 W <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 \ t <br /> home additions, and bunkhouses.** 11- <br /> / <br /> reel-c4( SektpGC,f�s <br /> .4 C(e 5 41 A win b e( v,e bearoo�/}%5 I/l. 4-� <br /> reit v <br /> �5O c 1 G�,�,e. perm et. Qj/ con eKicA o C� x Fee Rec: ��o <br /> 0 NQe� a.c� � �) e b ���� V �(f C� <br /> co/) ��1�1gGr I��It,l �j ct ro�q r o Check#:GS`- <br /> Date of staff site visit: ` 'I1 1 4 V InitialsInof site t staff: �'` m <br /> i Ci J 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: fA DATE: /57,;2/ giiii <br /> a Cr) <br /> UPON APPROVAL: APPLICA UST POST COPY OF '� W -D V <br /> .- Ril-- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTN 2 <br /> Transcendent: - Page 1 of 4 ,'3 <br /> Laserfische: II <br /> Burnett County,WI Land Use Application—Rev 12/2020 ''? <br /> 3 <br /> b <br />