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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line Ci" `N <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> d F. <br /> Dwelling/Principal Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 jv` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> VAccessory 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 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° Tb <br /> Filling/Grading $150 Boathouse $500 r <br /> o J r,%_ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 (b <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 /> Property Owner's Name: fl %'\( Q(�. Off 1 �G'kK-�1 S o • <br /> *11 <br /> Property Owner's Mailing Address: 1 I O l�' CCi lti L i 1,L% C I�11���tV E <br /> tJ • ity Stalte) Zi , . i 22 .o <br /> Property Site Address: ?ct 5 ) oL)A ei R L a n �r <br /> Contact's Telephone Number: G i _ 'J� 3'-99(.('c n o <br /> e <br /> Contact's Email: (VI -E Cil(i\<CA �;Sic-'9�1c( i ( . I <br /> Legal Description of Property: 1„D 1- i CSC)) V. 18 P95;v2 <br /> r N -o <br /> Section#: ;Q Town#: Li 0 N Range#: 15 W Town of: S//teecon 0. 00 <br /> N*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property Page.* C: <br /> Tax ID#(1-5 digit number; found on tax statement): 5(.04-3 <br /> 1I <br /> Proposed Use of Structure/Addition: �j (( / 5i1)1r(,((.L) <br /> � N o <br /> Anticipated Start Date: (Home/Ca ;Commercial Business;Bedroom;Deck;etc.) : ; 1` 1 >''< <br /> W,1\ g d <br /> Building Contractor: Sewer Installer: v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V,. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N. .., P f)1 :, i, <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 N <br /> home additions,and bunkhouses.** 70 % <br /> /;115 i MC7 I'S -tv1^ 1 6 S4' kt)A 4 / s e c S / <br /> Co IA112u N 5Aow mlAf—©F �r00�p1,�, I�'`1 <br /> 9eli,,e_el no,- -0 he asa .At Aulmoil A 1 <br /> 94. <br /> c) ve -21-1 7 el Yt9 IJP c t,(e//N Q ' 077€9 /e9C� e9Li e1"14QN s °t z Check e#: rJ IJ <br /> Date of staff site visit: i 5 c� Z Z Initials of site visit staff: j 72 �C) <br /> 111 d /2 a e-? <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: / , DATE: 2AS,ZO 0-7 < �C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y) a G <br /> y IR .. -u <br /> �, me -a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT — ff <br /> 0 c <br /> Transcendent: - Page 1 of 4 N <br /> n 94 Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < §. G <br /> d <br /> a l= <br />