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, . r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI 6 <br /> Applicant Complete All Sections Below This Line 5 It <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e <br /> N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 °�, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 SO <br /> n (/ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° V <br /> Filling/Grading $150 Boathouse $500 r- �1 14o N <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. ? % <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 /> o <br /> \ <br /> Property Owner's Name: D cx VN,b Pte ' -' t ✓1'1 t'-I. P_r z <br /> 2 pp <br /> Property Owner's Mailing Address: )7/ 75 CIV, R , C id e-65/ Cr, !,t/i' 5/71,S ? °o <br /> _ // City State Zip <br /> Property Site Address: 7/ 7.� Ci'y, Re.), ,C. t..,) e_bs 71 e r, 6)i. ,..5,..5"--V13ci <br /> $' D.7 <br /> Contact's Telephone Number: 7/5 (p 6- ' - 7206 0 <br /> t 0a <br /> Contact's Email: CA j44 Z i VYI 111 O Le_ry-1 U.r y 4-r 1, 4e- d <br /> Legal Description of Property: <br /> Section#: a S Town#: Q N Range#: / W Town of: O <br /> l 0 r1d 0 a <br /> cro <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g <br /> Tax ID#(1-5 digit number; found on tax statement): / 3 a 0 0 q. <br /> Proposed Use of Structure/Addition: £i)pp A V )1 P_A y <br /> Anticipated Start Date: f; ' s{ Idea k Piety (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ` -ze, '''1. <br /> Building Contractor: fpm erIC�n .5)`e e) Ca r far 4S, Sewer Installer: ' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r c <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • <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 Or any dwellings,dwelling additions, manufactured homes,manufactured z II <br /> home lditions, and bunkhouses.** x <br /> Arie0- a 5404ctig <br /> 0 filo - ( 1u,,() kit kr.,13/.4- --1 °11 <br /> 0 i t C 46\el (5 Ile,ee 045 ,p1)(c. X 4 4 * 61107?- <br /> Ri Fee Rec: /5 <br /> u/ /2� ' Check#:j5 7 <br /> 16L <br /> Date of staff site visit: Initials of s' e visit f • z <br /> APPROVED BY LAND SERVICES OFFICIAL: A DATE: 1106?"?' . <br /> UPON APPROVAL: APPLICA ,0 UST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .: g i Guy <br /> yo <br /> t= <br /> Transcendent: Page 1 of 4 ni i n <br /> Burnett County, WI Land Use Application - Rev 12/2020 < 3 "'' <br /> Laserfische: - a cp NI <br /> b <br />