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- LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line O' <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> 1;3 <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 t- ,71 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ",-t- <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Cc V) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 C- N 1 <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. AD <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 /> / I. }j�l> <br /> Property Owner's Name: ]CFi1` f ,r PP1 /bp o <br /> Property Owner's Mailing Address: f� rU ; e„...,06e T"#► g <br /> 7 City State Zip -ii,�' II 11. <br /> Property Site Address: o' n <br /> E ll' <br /> Contact's Telephone Number: ( V) 72(f--2677 o <br /> E. <br /> •Contact's Email: f\ jt It Cc/VIC:GO ' f e--T d <br /> 1~ <br /> Legal Description of Property: w C9's /OG 6'f bj(V /c i"' -2- <br /> 0 o <br /> Section#: 2 Town#: , ? N Range#: /+1 W Town of: / egnon E. 0 <br /> Go additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system roPertJPa e.* <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 33S- <br /> -J T 2 5' <br /> Proposed Use of Structure/Addition: n,t7 ("I:1-v1C�I6Se4' "' <br /> Anticipated Start Date: I{-Z6 — 2 Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> '// 47 <br /> o <br /> Building Contractor: dOr� `{.E// Cp/t�1`l✓� 'is( Sewer Installer: ` 9--� ^ `� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ') <br /> Ut <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to ....0 <br /> _ S) <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** a <br /> il(116 eA- c of s �Gts <br /> 0-vellX1 rte- -D ecc- ? beclapeois pry 546 lgsL1�{,) <br /> imp Cep-.► � S <br /> Uri ,AA^ 4 be. c0 1 e.-g b !b/ 112 P' <br /> 1 - - ( <br /> r s1 v1/1 (e/l A� t'K SG'� x Fee Rec:- 0 r <br /> -b 1'rlct, U5 <br /> Check#: Gl 14- <br /> 3/31 /2-� m <br /> Date of staff site visit: Ini 'als of sit visit st. ': z 1 <br /> 1 gird� // 11 <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: L "?� <br /> UPON APPROVAL: APPLICANT , ST POST COPY OF c: is <br /> is <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> '< Ka <br /> Transcendent: - Page 1 of 4 IV <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> ILc — ) <br />