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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0) <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 d 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 — ;; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r• — <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CA <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. z <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 /> Property Owner's Name: Ala' /� G l`C h Z /�- ° z <br /> ' o <br /> Property Owner's Mailing Address: /S 7 v 7 cS!' G' 7� /) � /f� 7 ` o <br /> w h-s key Rr t�,- ', 17-7.- zed <br /> L� City State Zip 0. <br /> /7 <br /> Property Site Address: / Cir Road t vc.6 ee lvZ 3E93 r n 7- <br /> Contact's Telephone Number: �- 3 6 - off'�o ?6!4vq 41RZ o <br /> �75 <br /> OD 7 <br /> Contact's Email: etc K ' /1'I c./�C-n Z/e 1 n accfr.'L , Go/ <br /> I r 0^� w <br /> Legal Description of Property: LO* br A/f t/e C0 Ce'� S. ......"0 S 66 ... <br /> N 0 <br /> 0 <br /> Section#: /3 Town#: 3 (9 N Range#: / '7 W Town of: /�CO�i1 o <br /> B' <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> P <br /> Tax ID#(1-5 digit number; found on tax statement): dCcq. <br /> Proposed Use of Structure/Addition: /97v S et, SAci:):> ,, <br /> -, -3 <br /> Anticipated Start Date: /(/0t/• /5 02002 / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 x <br /> d <br /> Building Contractor: /''Iy5e// ,S71.." / Sewer Installer: <br /> -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ` th <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <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 <br /> home additions,and bunkhouses.** 144.6,. 4),�h z "JZZI <br /> 0 I\)6.15._ .c ( 111/44,04e,,4 Ito <br /> 0l —at 5 <br /> i' Fee Rec:i/6V <br /> 4 Check#: 731/ <br /> / / / v <br /> Date of staff site visit: 10/ l P-� Initials of 'te visit staff: / = —► <br /> �>r i <br /> / n< <br /> APPROVED BY LAND SERVICES OFFICIAL. ./� DATE: IN;9!�./ r-n <br /> UPON APPROVAL: APPLIC A ZMUST POST COPY OF ? <br /> irllii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> yI a <br /> go <br /> Transcendent: ^Z i.::...,Page 1 of 4 3 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 =5 <br />