Laserfiche WebLink
FA <br /> Applicant Complete All Sections Below This Line 0 a <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 P4 <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 d <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \ K <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ,(� <br /> Filling/Grading $150 Boathouse $500 o S. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> v <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. E. <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 Namer--/ cT Jii C :.,, 11 e,/ /,. i, o 1 <br /> Name: CJI <br /> Property Owner's Mailing Address:/6 / -7 S"f, u h 'i v.e (-h&S Cwt MA-)��3 i t1 a '� �_1 <br /> City State Zip �+ ,n <br /> Property Site Address:021-/ip 7 2 _ein r G �� N u.! i ,, F:, Sp0vn 2 r'' E (W)A <br /> C � <br /> Contact's Telephone Number: 6),S-2-s.---C)0 - /() 0 (,) � <br /> g <br /> I ii IIa <br /> Contact's Email: S5 Eil be.' t c k (V Ci'�'-)�'1 Gt.,L't�GC, 1 I. C azr-/ d <br /> Legal Description of Property: 1_.i 1. C S rYI \f2) i-D,.7 0 ( 3 Ic V, &`� -7 ) <br /> o a% <br /> y <br /> Section#: Town#: 3S N Range#: 1 Li W Town of: <br /> --- -5,s,..0 <br /> �j <br /> l . <br /> / 5 <br /> IQ <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPaSe.* CI. <br /> Tax ID#(1-5 digit number;found on tax statement):Q/ 2'i 1 <br /> � <br /> Proposed Use of Structure/Addition: CaP CC `" <br /> 1 .- <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i <br /> .S1 <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 ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufacturedhome additions, and bunkhouses.** <br /> di r�ee a, it 5e�c x ;fes q /As/ a-� 1 <br /> 0 n11( { i 6,i12e- P <br /> ^�o-4 six Cal4edret +r, •%/1,./V1 3,54e4 41#- q 1/ 41;41<-S. <br /> x Fee Rec: / j <br /> V5e f VC k,✓ Ca N!t3 pug' t 4- 0,��I,y r. . 1 i ?C>d-3. Check#: . <br /> t- <br /> Date of staff site visit: 31 2"/4/a" Initials of site visi sta a <br /> l. i, 7 o <br /> APPROVED BY LAND SERVICES OFFICIAL: % r DATE: 315/?2 '' �Z-=� <br /> n g <br /> UPON APPROVAL: APPLICAN UST POST COPY OF y m �= <br /> mCO 70 C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTp.,..1 <br /> 0 <br /> Transcendent: Page 1 of 4 g g <br /> N <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 j- N <br /> o CD <br />