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LAND USE PERMIT APPLICATION- Burnett County, WI <br /> I <br /> y N <br /> Applicant Complete All Sections Below This Line ° <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> A Accessory Structure(Garage,&I etc.) $150 Addition/Alteration to Accessory Structure $150 v i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - <br /> C1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 • 1, <br /> Filling/Grading $150 Boathouse $500 ° <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. r <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 /> T ,I1 tT�J - �C E.Property Owner's Name: V� � 'L <br /> k � �ree l G(11/ o �^ <br /> Property Owner's Mailing Address: <br /> 3SO Roil` S+ N W sCD>nst" Rapids 41) I Sy'l9y <br /> I City State Zip b <br /> Property Site Address: 2°115 J. k►,Ce_ La.K.4.. ed. Spo o ncr V1/S 91701 I. ren <br /> Contact's Telephone Number: N.-A "n5-21311355 Mike 6S-1 -2.70.94S-7 o � <br /> _ a <br /> Contact's Email: Thevice.L.s es,. .) .c„,, t j,,'\`rout it1e-7c0gma;I .00w d ,C., <br /> -- ` r <br /> Legal Description of Property: See Gtte�rr+t C MCA+ Ceabt W <br /> n c . 1 <br /> Section#:S 10 Town#: 739 N Range#: R 11 W Town of: R tt 1c ._ <br /> *Attach additional page i f needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* " ll <br /> 5. <br /> Tax ID#(1-5 digit number; found on tax statement): 15 7 6, <br /> cg <br /> Proposed Use of Structure/Addition: /� � U S'hbf t5 e W�eG� -e Pre�p .- `� <br /> Anticipated Start Date: <br /> (-Lie 4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y <br /> \J (ki <br /> / u,1d„Old K, =� <br /> Building Contractor:A�}�u2� `V¢1`4We3 B �5S Sewer Installer: n/Q- y <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 front them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** Pz <br /> • r &— a I l 5eA-bc.c/I45 <br /> 6 MA— ccor Leivo 114„bil-et4;c5ric. <br /> z Fee Rec:1'S0 <br /> 4 Check#: [45,2,9 <br /> ,29 <br /> u <br /> m <br /> Date of staff site visit: 10151 .1 Initials o ite vis t staf - . a <br /> /. /A/ t7 <br /> APPROVED BY LAND SERVICES OFFICIAL.,,74 //. ' DATE: 10/5$2't . ' ___c <br /> "for _.;__DJ <br /> UPON APPROVAL: APPLICA '" UST POST COPY OF o fill <br /> CWCD 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT " .m <br /> M n __ Y�+Y <br /> Transcendent: - Page 1 of 4 . c o <br /> Laserfische: - <br /> Burnett County, WI Land Use Application-Rev 12/2020 v <br /> Q <br />