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LAND USE PERMIT APPLICATION— Burnett County, WI f <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) p- <br /> --i? 4 <br /> millant Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '.D. O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ry <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> o J` <br /> Filling/Grading $150 Boathouse $500 r- (.() <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. R. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ia Property Owner's Name: N,cIC 7`� �/ih /)as1.26,6%?_ z ,P1'r' <br /> Property Owner's Mailing Address: fes'/Z /� t 6 f A/6— letAl<ST�� , 2i/ SS j o �� <br /> n '/ City State Zip t' I <br /> 111 <br /> Property Site Address: �'7 yy 7 ( vyx /2p ,1 <br /> E <br /> Contact's Telephone Number: 5-U7- 25/-- 5-5O5' o g <br /> n. <br /> Contact's Email: CIA mP- 3 ,C/l/ g)///nine. , Cbl ==> p L: <br /> Legal Description of Property: /V ?C , 9 ?,2E 56" //t v v p <br /> Section#: .$ Town#: ;f0 N Range#: /9 W Town of: ,.. e.",77- °_ °° <br /> 5' <br /> riq <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): / 7 Y 6 -.' <br /> Proposed Use of Structure/Addition: (JGNt1r/2S,td/t/ O L7/4kri6e- j7 dt,,-;-i=LLl/V(7 <br /> ;i' ' <br /> `. <br /> Anticipated Start Date: Ci C7— Ze'z J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: ( 111. 7-,2�tC/-/CA/ Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **7lte applicant needs to contact their ('DC Inspector to determine if a permit is needed front then?prior to .� <br /> ANY construction taking place for any dwellings, duelling additions,manufactured homes, manufactured Z <br /> home additions, and bunkhouses.** 7v <br /> I vJo-F- -}v ekCeed 3 c)fvo✓'M or G ocuxe``f <br /> f- <br /> in'le-4- cat 5 <br /> l' Fee Rec:-300617 <br /> ci Check#:t�/7 <br /> rr <br /> o <br /> Date of staff site visit: 91?q I O/ Initials of.ite visit staff: '/ a , <br /> 4, 4r <br /> • <br /> w � / /. . X 913°%/ m3 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: < m <br /> ci <br /> UPON APPROVAL: APPLICAMUST POST COPY OF 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 m 3 ' — <br /> ag <br /> gill <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < _ <br /> m L 1.:1)d <br /> K <br />