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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line °. <br /> CD I <br /> Q. <br /> Permit Types and Fees:(Please,check appropriate boxes) a ---.1 <br /> Dwelling/Principal Structure $300 )(Addition/Alteration to Dwelling/Principal Structure $200 ?: `- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n `� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 0 If <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v) r <br /> *NOTE:After-the-fact permits(permit aqui red 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. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: C- h t s D A rv, a `'v- <br /> t k o <br /> 0 <br /> Property Owner's Mailing Address: Q SO N }-{-o1 wk. i+ek v-e--'n Dr II-TA/ware( WI 54 X43 $ <br /> City State Zip `c <br /> Property Site Address: 2-OS Lf 3 £ P-o ott.e-•( LU-1�-e Dr 1 Spvbb-tom- wi S4KC t E ,.nom <br /> Contact's Telephone Number: -11 S X05 ' t �� o c <br /> Contact's Email: U3‘21 a.irk.a5 K.-e..-.rI ps & 1 YV, I l , G Z n'1 \ a <br /> I? <br /> CD <br /> Legal Description of Property: c,hn tkb C tIe"'-s N OY--t-. we CAS S wb44. P-64'414'4-1 1-4V-e- lid tie <br /> Section#: 1\ Town#: u{b N N Range#: L Lf W Town of: Sc &-et- <br /> Rik.-2 t,;1 <br /> ro <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa e.* <br /> In' <br /> Tax ID#(1-5 digit number; found on tax statement): 19 O U <br /> Proposed Use of Structure/Addition: C a�'i'c1 c e_r1 e v o\„{-i'v - cA <br /> Anticipated Start Date: o w <br /> p �S Pcp (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � x <br /> Building Contractor: �-c� P`\\-eN Sewer Installer: be Y r i O\S ta t7 <br /> 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: • <br /> 1. O <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.** z 1 <br /> 6) 6 et N\f pGhCI ,�� -����a/, <br /> 0 a n /`?Y' S y s74-14,1 7j L - / 1.57‘//e/ey <br /> y <br /> ,..9//0,o. Z d, Fee Rec WV <br /> 4 Check#: i 37. <br /> -----/ <br /> 9 -�na �� <br /> Date of staff site visit: l I �/ Initials of site visit staff:IP , rti <br /> z --� �� <br /> �Z/�zOz/ rnr <br /> vi <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: n a rl <br /> 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 15 r' <br /> a 5•0 r <br /> 1111 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° .0 <br /> C <br /> Transcendent: - Page 1 of 4 W <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 12/2020 < a <br /> d <br /> ti <br />