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0 - r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a 3 <br /> 5 <br /> Applicant Complete All Sections Below This Line <br /> (4 t) ' <br /> Permit Types and Fees:(Please,check appropriate boxes) Q <br /> z <br /> Dwelling/Principal Structure $300 V' Addition/Alteration to Dwelling/Principal Structure $200 iv ' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -U O xJ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ^ $ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 '- 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° ,. <br /> Filling/Grading $150 Boathouse $500 r 14 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension Allowed Once) $100 P <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> �1 <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 /> Q, <br /> 3 0 <br /> Property Owner's Name: ! i . <br /> Property Owner's Mailing Address: . . lb-7 F-I/`tic • I tJ2 L% ,<---orz) ralI5-1 <br /> � //��� �/� City State Z <br /> )13U tv O�J�� l +SICU F0.' L� �� <br /> PropertySite Address: Sr 'v 1.J—L <br /> [t:k9 / --''' <br /> Contact's Telephone Number: Lu C944 7 r v Wot d 7" SJRo <br /> el <br /> Contact's Email: !t 1 K- S i<)q a V M I Ce , C <br /> Legal Description of Property: Set,3S Tn IID SD 4 / V/s 'GovL f.3 Ly, 1,44- 7vo�1 t ' c' G <br /> ' f N <br /> T <br /> Section#: 35. Town#: 0 N Range#: ii, W Town of: jr.'i Ls/.f-• C °' <br /> 5 <br /> *,4ttach additional page if needed,for lengthy description OR attach a copy of the deed OR attach tax system property page.* ',-,- C <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> I �r�3 � .� <br /> Proposed Use of Structure/Addition: L.1,U,e„' r 2uo (k's i-e�7�e.,r� `-�tJrf?c nt s) �_ `" <br /> Anticipated Start Date: „`'—i c,/;L, a•(?;La. (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) \ F x <br /> Building Contractor: Sewer Installer: IA-'hel' . <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY _Z. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> "'The applicant needs to contact their ['DC Inspector to determine if a permit is needed from then prior to W <br /> ANY construction tatting place for any dwellings, dwelling additions,manufactured homes,manufactured z n __� <br /> home additions,and hunkhc�rrse�''� )5 61' � �C���' �/�� 4411 1' I� t.L <br /> gitlee4 411 Sel:Lit + cJno:r is ul ' ,S aid used/woe <br /> gil CAin MAI* be �a >G t� es I s� be <br /> c' <br /> 30 �� Q *� ...r4.1 ( �, -�,J� ,_, Fee Rec: Cp� <br /> CO%/(1 COt L, ' 4. ,i7 Check#:CP ` j U <br /> D of staff site visit: 3 13( /p' Initials of site visit staff: �1 <br /> D 'e!lila tie-i- +o 3 belt - ,7.1 50- 20833 M <br /> APPROVED BY AND SERVICES OFFICIAL: A _'A.. _ ,f DATE: 51 f0/?, x <br /> �I � r- <br /> ti liiiil <br /> UPON APPROVAL: APPLICAN . MUST POST COPY OF a <br /> cmc n Vf! <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT u wRil <br /> CI Q <br /> Transcendent: Page 1 of 4 o v <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 r r< <br /> a 110 <br /> LTJ <br />