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r <br /> LAND USE PERMI PPL CATION — Burnett County, WI a <br /> cn N <br /> Applicant Complete All Sections Below This Line oN <br /> co <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> 04 Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 P. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> ly Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 GI g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �j <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° Q <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 rl <br /> Filling/Grading $150 Boathouse $500 v, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 = <br /> • <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. 7...- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g -, <br /> CT <br /> Property Owner's Name: LV�iloimP Pr�vO��i ~ <br /> (:\72')Nflike Ok.-JC: o <br /> t '� ! mei) /1e 1 <br /> Property Owner's Mailing Address: (" t c h ierti lr /Y14J $SO3F E - <br /> City State Zip c ' <br /> Property Site Address: gaifikeeW .1 bctl4bvrf (f..' 54 C <br /> c <br /> vi <br /> Contact's Telephone Number: <br /> 6,3 -4-1- 0993 a <br /> Contact's Email: rOn &ro i,Thi•G ow N b <br /> o <br /> Legal Description of Property: Lai- a Csm506s Vol.2Fl PoZ 67 v <br /> Section#: 13 Town#: N j N Range#: j l; W Town of: 6W;SS 5. <br /> 2. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 3 rS o <br /> 5 ) <br /> r7 <br /> Proposed Use of Structure/Addition: Va.w�w� h,p,�,t�,� `t' c�,a� • 5 V t 'V <br /> r` Q ) <br /> Anticipated Start Date: hau,1 I$:- a,c _ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) \ W <br /> Building Contractor: E V1(lnatin e Pere,3icS Sewer Installer: *ass Tv1 k'vvhr <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY p�j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z r <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 for any dwellings,dwelling additions,manufactured homes,manufactured <br /> �o�additions,and bunkhouses�'*� <br /> cek 4 l( 5e �. S �`�l�q5Q,�d rtv�- e� 3b rimsTer <br /> z <br /> 0 he e+ A 7, <br /> Date of staff site visit: s5/1,t1/2"001 Initials of to visi/.t. W aFee Rec: . a <br /> _ / z Ch- 11 <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: 5( 24_3( <br /> d--d i;:i =:= <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF <br /> tM <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 70 <br /> iffi] <br /> N C) <br /> Page l of 5 • g Z a @, <br /> Burnett County,WI Land Use Application—Rev 12/2021 al r•-> <br /> v $ <br /> a C: 4 <br />