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LAND USE PERMIT APPLICATION — Burnett County, WI 2 <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) A n S <br /> C. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $20012- <br /> ?: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "C <br /> _Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150Pv <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< 5 <br /> Filling/Grading $150 Boathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 C? <br /> cA <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. ft. <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 /> A /I C X Z C. R <br /> Property Owner's Name: r 2z <br /> /8 767 .S 7 ci 72 94t' AIN SS07y o <br /> Property Owner's Mailing Address: o <br /> 4./A i5 Aey Al fre ` i r/ �1 City State Zip n. <br /> Property Site Address: IO/1 / /7e 1r u...2":t4/e4/re' ,5/Z 3 n <br /> .7 <br /> Contact's Telephone Number: <br /> 4.5/-383 - 023o 4 ,�i N9 44,;( R.� E <br /> o c <br /> CD n <br /> y� /� , , 7 <br /> Contact's Email:/7/4/C • (.'ger/L C Q V Kt G /''G , GO Al C7 <br /> Legal Description of Property: LO4 )0A- ,(3dirne-# doc.,4fy tC� 3 Pi i .566o o <br /> a <br /> Section#: /3 Town#53�}7 N Range#: /7 W Town of: Zi/266//10. <br /> 0o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number; found on tax statement): • ' '-.1 ' • Ai r ' 35 gag 3. <br /> Proposed Use of Structure/Addition: /%otore7/O 5i j G ,- 3,04.,,,,,A i lc <br /> Anticipated Start Date: <br /> p A/0k 45 a0.1.7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � x <br /> 5 <br /> Building Contractor: /''►Y.SC fit. <br /> .94 a, Sewer Installer: Cs3 <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 Q <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes,manufactured z <br /> home additions,and bunkhous s.** x <br /> p reec 411 5 <br /> 0 1\k*scvc ImA, (9‘Alpacitb: <br /> 1' Fee Rec: �5b <br /> 4 Check#:73,23 <br /> I�pp <br /> // Q(�, Itri <br /> 0 <br /> Date of staff site visefol l/f r -` Initials ' site visit sta : 4r , <br /> 0, # /"lir <br /> APPROVED BY LAND SERVICES OFFICIAL: • / /1•0DATE:I0/ 2l / 7/ 1 NUPON APPROVAL: APPLIC s4 ' OST POST COPY OF c C <br /> SIGNED PERMIT APPLI ATION IN PLAIN SIGHT ' CD Na0 <br /> Transcendent: - Page 1 of 4 3 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 <br /> b <br />