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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> R <br /> b <br /> Applicant Complete All Sections Below This Line 0' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200ti <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 0 <br /> 4 o <br /> Driveways/&Campground Structures $125 WI State S�atute 59.692(1v)Structures $350 o p <br /> b <br /> Filling/Grading $150 Boathouse $500 <br /> P Z <br /> PD <br /> _ Permit Extension(1 Year Extension-Allowed Once) $100 <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. i4. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> 0 <br /> Property Owner's Name: R I CHARD /\, 1-1EtSRI KSOI.S �EJoeE.Aal., t_,id►,J L T 1 <br /> 'FRO Sr 0 <br /> Property Owner's Mailing Address: —7 Co Sy LA PLAN FE DR.. DgwS6O1z.y W( 544'63° '' <br /> n City State Zip C <br /> Property Site Address: .2ri 5 cp C AST \ieLLO W g l JErZ tD 2— •• a <br /> Contact's Telephone Number: Cp( 2—7 4-1 3- 291 (FA T . .FF RC') i. <br /> n <br /> Contact's Email: VP S EFF .EI e IA r(oO, COM N ' <br /> ao <br /> Legal Description of Property: ac <br /> F. r <br /> Section#: I $ Town#: LI O N Range#: 1 Lo W Town of: OAK.LA N P `\ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): ft-'' S 1' F <br /> Proposed Use of Structure/Addition: -17) C-V-17) C-V___C _ <br /> d <br /> Anticipated Start Date: APRIL Z 3 (Home/Cabin,,Commercial Business;Bedroom;Deck;etc.) H <br /> • <br /> Building Contractor: JVOta C Sewer Installer: N/A Ir <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 1 <br /> **The applicant needs to contact their I.DC Inspector to determine if a permit is needed from then prior to <br /> ANI'construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> hot additions,and hurtk-�seF.�� <br /> d PIMA- U 'IL.1ln1 <br /> 0 ), { k/.kn L.bt-1 d O <br /> el ( u f kee SA/vie a/ic "-1 o,' )655 ,./yelo' kS Sur&ce. <br /> T <br /> Date of staff site visit: i'd-'u/?- ,9 initials of ite visit.to": 1 4- P2 Fee Rec: lob -- <br /> 1 <br /> d Check#: F333 <br /> APPROVED BY LAND SERVICES OFFICIAL: ',f ,/ _ <br /> / DATE: LI/Li /2? tt <br /> UPON APPROVAL: APPLICANT% UST POST COPY OF <br /> a m ( <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> `i)r m <br /> fill <br /> Page lof5 <br /> § C o0 0 <br /> Burnett County, WI Land Use Application— Rev 12/2021 m co ," <br /> o w .< cm <br /> a <br /> i <br />