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LAND USE PERMIT APPLICATION — Burnett County, VVI a 2 c <br /> • <br /> w <br /> Applicant Complete All Sections Below This Line o' <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) J p -e <br /> . t6--- <br /> 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 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 co <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ; 6 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ; <br /> Filling/Grading $150 Boathouse $500 j r- <br /> 0 <br /> :Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> C4 1 <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 /> r B <br /> Property Owner's Name: O i�v e L t r ,r -,, 1j��1 e-(/e-(/`� ° z <br /> Property Owner's Mailing Address: I � U 2 CL A(O / r` ee'evl - / & `�,(b -f . <br /> a <br /> �j Cci City State Zip a <br /> Property Site Address: I Z1) i )i (p C1 v.1 Q�S-p-,�j ��,t � gc e 1 LI G k27 ' <br /> /' z' < ov a <br /> Contact's Telephone Number: 6r,,�r,z c7 f t vl .Pia✓ 71s-,'f'?1 ' S7 36 a ._6� 11 <br /> <,. a ■. <br /> Contact's Email: et'-- r SP (i(k n ( e✓ dG�1 i (eel; < ' - <br /> Legal Description of Property: <br /> Section#: 2- I °q <br /> m� Town#: N Range#: �� W Town of: l l Z/�Ile_ �Q <br /> 5 <br /> c/o additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system property page.* <br /> p <br /> Tax ID#(1-5 digit number; found on tax statement): 2-f id 1 e, <br /> Proposed Use of Structure/Ad itio : �.'('4 1ZU O Nt. �- EPur 2.y/ ,�v90,r1.�1 "' <br /> Anticipated Start Date: a 5_ <br /> p �(, i i ( I (Home/Cabin;Commercial Business;Bedroom;Deck;etc. & x <br /> J <br /> J a 0 <br /> Building Contractor: J e Fe. �6,J� Sewer Installer: &F 1 Sii ' D`h wl (J9►1 <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,manu actured homes,manufactured z <br /> home additions, and bunkhouses.** f I ��M, sQf l� ?b� nja/'L <br /> 0 D„�lt• i11W1 ekce>e sci <br /> & e' as Se%Aciks <br /> igp 'rr :4' , l. *4-,i). Peed J ►1dk n LK dC Qa <br /> :0 I S,!e <br /> .'f` x Fee Rec: O2°d <br /> 61 <br /> t? ail!a (4" a, Ckineee <br /> 6 Check#: 0/So2(.2 <br /> /5 /)- l I. ° �' `9 s`/�-,ate►'" <br /> CefeTftje.ite visit: Initials of site vis' staf / ; <br /> Pa bk +vt} r, y pN�R• J l lad / <br /> APPROVED W LAND SERVICES OFF CIAL: DATE: oleo' I <br /> UPON APPROVAL: APPLICA Y MUST POST COPY OF '.cci <br /> ac V Ill <br /> It <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTia„ <br /> o d <br /> Transcendent: - Page 1 of 4 I.‹` <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 VI <br /> ' ' J <br />