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LAND USE PERMIT APPLICATION—Burnett County, WIcr <br /> * , N <br /> Applicant Complete All Sections Below This Line 0* a ';�' <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <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 „..2•••• 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> A <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 _, <br /> rn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a 1. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. . a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -iv <br /> 7 r 1 <br /> Property Owner's Name: ..J i 11 I 1'!.1 ' . J aCal L Lt i-40r-e i L 9 o C <br /> Property Owner's Mailing Address:.21-0/ � � F'_ COoleilh.' (,t.'* -� ,:4' 87 r <br /> j City State Zip -0` <br /> Property Site Address: 2'1" 1 / rr. yell' rrAA`l 3)-411 s!L{I(L ka. .1,-/•'S.s? / <br /> Contact's Telephone Number: (1r b/ -^.5ds- / ° c <br /> 7 P;a ,r <br /> Contact's Email:J ear) to i_ J 1`C.r) e—`op,�m to 1 , CGm d rr <br /> ., <br /> i✓SCvov cr SIJtInE n&- DesC-TA 55a/5x1- rD I.% <br /> Legal Description of Property: ( L(-+'-) 7343 D -I .5(;) <br /> I`-,1 a xcir P <br /> N b <br /> Section#: f 63 Town#: 3 co N Range#: / W Town of: DI c?`t' v 0o� <br /> / a. <br /> no <br /> *Attach additional page if neededjor lengthy description OR attach a copy qf the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): 3 0'7 D <br /> Proposed Use of Structure/Addition: Y8i 1(� X!h /VC,I k' -1.L(, 2- CZ1(21T - .; <br /> I Anticipated Start Date: ( (` . )'CSI (Home/Cabin:Cor4nfercial Business:Bedroom:Deck:etc.) ' s <br /> d <br /> Building Contractor:,/n 0rili ljf d &( ij d I/16 ' )I <br /> Sewer Installer: A <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 GDC Inspector to determine if a permit is needed from deem prior to Q <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> hon /additions,and bunkhouses.** x <br /> The e4- a<< 5 bac., <br /> IV 04-- f - 11,4,410011,4,4100 /►bbl +104 ".4 <br /> = Fee Rec: /67/19 <br /> I / ff v <br /> Check#: 1Oil <br /> Date of staff site visit: / '�` 1 Initials o site' visit staff: z <br /> OFFICIAL: tl', )///'D TE: 111 T / /�I t • . <br /> Pir o ' .,, ,,,,I.--,__j <br /> APPROVED BY SERVICESLAND <br /> UPON APPROVAL: APPLIC a MUST POST COPY OF 71 <br /> 1 n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> ' <br /> 1 of 4 <br /> Transcendent: - Page <br /> Burnett County, WI Land Use Application—Rev 12/2020 gifa <br /> Lasertische: - 1.7—A <br /> r <br /> 3 <br />