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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> CA <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O L)J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 w <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ' F <br /> Accessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 <br /> { Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 (__ <br /> n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures _$350 o G <br /> Filling/Grading $150_ Boathouse $500 r- 3- <br /> • <br /> 0 <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. 7 <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 /> Property Owner's Name: ,f�,n A -410) Z o <br /> ri <br /> Property Owner's Mailing Address: /5-6 SA c j C Ape), Vo /fey jf✓ 55-12 4 o <br /> � _A /City / State Zip i <br /> Property Site Address:} �CO-V g 41S t!4�e / f /✓e..h b wy 6-1 $N 1 j a <br /> Contact's Telephone Number: S I- (-15-1 //- / 7 2_62o_ <br /> Contact's Email: T ohn . Avi Ac,/2 62 ho 4I'i''CAt`i • Co vn o <br /> o <br /> Legal Description of Property: X, 13 ki 4 0 a 7 17 lit 6OV L OT L} <br /> N u <br /> Section#: /3 Town#: 4U N Range#: / 7 W Town of: (..,t vi ton <br /> 5 <br /> °0*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number; found on tax statement): Z 4 6 <br /> cl 7 <br /> Proposed Use of Structure/Addition: O c. /40(AS e i <br /> Anticipated Start Date: .1.-3 - 2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) l ,- —] <br /> E <br /> 7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their LDC Inspector to determine if a permit is needed front them prior to .. <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes,manufactured z NO <br /> home additions,and bunkhouse x x <br /> O'Vof- 740 be. use1 .. be' LiamaN tietlog7oXze,Pt/ uSe. -{vr <br /> .S 4 tore O A /y• tx f rrn y 6o40714D u s e. `cat no <br /> Sec+./..i,`y/4a ,,,pe, Space. pep lac v tv.f- 66c 1avSe....., <br /> 1- L J� Fee Rec: — <br /> I� D e ,�] G(e-- .s a INI e_ Gl [�1/� 4 �/l use, o Check#: �C l <br /> i- <br /> Date of staff site visit: 6/3 ea 2 Z Initials of site visit staff: / X a <br /> z <br /> 0 :APPROVED BY LAND SERVICES OFFICIAL: DATE: //�ZZ z <br /> 91— <br /> 13) WO <br /> UPON APPROVAL: AP ICANT MUST POST COPY OF c, a <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m = fV <br /> r- o o <br /> Transcendent: - Page 1 of 4 m <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 < 1q ^' <br /> ri o 4 <br /> a <br /> K <br />