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C <br /> To <br /> r. N <br /> Applicant Complete All Sections Below This Line ° N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD & <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \o <br /> XAccessory 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 & L' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r-, �? <br /> Filling/Grading $150 Boathouse $500 <br /> P <br /> Permit Extension(1 Year Extension-Allowed Once) $100 = <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. 54 - <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -1` <br /> 11 p <br /> Property Owner's Name: . z$1 r 114 f1 ( e ,go y k4 4" 0 <br /> r <br /> Property Owner's Mailing Address: , tealip44) 1� <br /> p XXX <br /> L� � � City State Zi c 0 ha <br /> Property Site Address: 2�Y wi 5 c3L <br /> 0. 111 <br /> Contact's Telephone Number: <br /> 47I 1 — - 145 -71 Z i <br /> Contact's Email: tdhoc(i. ''l' 5 fJ C� 'J Mk I •• eL N <br /> ilk <br /> cro <br /> Legal Description of Property: 4` 5Ge.-- G t ►z't C cot* d <br /> Section#: Town#: N Range#: W Town of: OG kitod . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 13 0 9 /',.7 ` Io$ <br /> Proposed Use of Structure/ dditi Vt —/TL� <br /> Anticipated Start Date: 6' (17/ZZ ( y <br /> Home/Cabin;Commercial Business;Bedroom; eck;etc.) <br /> Building Contractor: AsioQ' jIQ lid . '(l. Sewer Installer: Al v.. <br /> r-- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> *The applicant needs to contact their UDC Inspector to determine if a permit is needed from there prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured <br /> ti <br /> home a -r- <br /> �01 <br /> ditions,and bunk louses. * b ene+ 1pc, lc+ �i fef 151 <br /> 1h1p � ~c[egr44;0 5‘..ev t CC51)1) ,Y1:447 be d ile <br /> CoA%b;at. I�t'S a4- -h,nrl a �;-1- e,r it-d:0/► • t5 /leek." <br /> eC�ed FelIPl <br /> (Veyi— r rka.4 �l a , CV 5 �(11655 #: 0---c)! <br /> 6. <br /> rri <br /> Date of staff site visit: LI/141 1?3 Initials of site visit st. f: ., L <br /> 2.0„,. z <br /> APPROVED BY LAND SERVICES OFFICIAL: fa,- r DATE: I be)la'sl. <br /> • / W 11u11 <br /> UPON APPROVAL: APPLICAN UST POST COPY OF c -0 0? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT v o � 0:H <br /> Page 1 of 5 `` N <br /> Burnett County, WI Land Use Application—Rev 12/2021 1 OW <br /> LTJ <br />