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b r" <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line F t...cN <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> (. PleJymg/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure ,''_ Addition/Alteration to Commercial/industrial Structure $200 c)c <br /> )4Accessory Structure(Garage,Shed,etc.)"$150 I Addition/Alteration to Accessory Structure $150 f..ii <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c-. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 Wi state Statute 59.b92(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P (L <br /> T <br /> Property Owner's Name: VIM A MAIVNIDUS o <br /> Property Owner's Mailing Address: 3oa�a ri Ave N Pc71, t . \ S :,L. rn <br /> a, <br /> ��,,r�_� p��u City State Zip < <br /> p/1 <br /> Property Site Address: XXX NZY Ft DAM .y wi ,q <br /> Contact's Telephone Number: 11S-14111-- y3,b <br /> F <br /> Contact's Email: LitiZWIL @ 6M/t14. COMA N - <br /> Legal Description of Property:g Wkip QF '. 4(F 'O NU SW dz., <br /> P <br /> Section#: lak Town#: UD N Range#: 17 W Town of: VNIDN <br /> *Attach additional page if needed for lengthy deccr•iption OR attach a copy of the deed OR attach tar system propertl•page.* <br /> v) <br /> Tax ID it(l-5 digit number; found on tax statement): 3bCbl8 0 <br /> . � <br /> Proposed Use oI'Structure/Addition: O e1fa(', �A�"Gt'� DH <br /> Anticipated Start Date: mkt 1,a, t (Home Cabin:Commercial usineccs: rdroom:Dec :etc) <br /> Building Contractor: UI iii IMArtIouS Sewer Installer: C v� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> .4NY construction taking place for any dwellings,dwelling additions,manufactured owes,manufactured <br /> home additions,and bunkhouses.*" A r ,,,�/� iesb.,,,A7ltrs pe;r�i ir5 -Cv 7`t ��'9 m�e <br /> : <br /> /(Dol" � be- 1,� -f Auw e v b b �',4:69,1 <br /> �, <br /> 6" <br /> Date of staff site visit: '�1�h� Initials of site visit ss+ .: Ice Rec:#454 le <br /> � <br /> i e Check A: 'b5i7k,, <br /> APPRO'V'ED BY LAM)SERVICES OFFICIAL: 61/ /6"' DA'Z'E: 5/6.09 z <br /> f4/ <br /> UPON APPROVAL: APPLICAN / UST POST COPY OF r <br /> 1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a r Iiiii] <br /> Pagel of g <br /> Burnett County, WI Land Use Application—Rev 12/2021 r,1 v o `c. =3 <br /> a <br /> 3 <br /> b UW <br /> R. V <br /> Lt....:..... -4) <br />