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LAND USE PERMIT APPLICATION — Burnett County, WI G <br /> '0y• <br /> �--i <br /> Applicant Complete All Sections Below This Line 5' C St ' <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> ' Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e <br /> Filling/Grading $150 Boathouse $500 0 r. <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 aqui red after construction has begun)may cost up to three times the normal fee. t. ( <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. $ c <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> o _• M <br /> Property Owner's Name: —FI(') tN <br /> S ) z <br /> ( �j' o <br /> (� <br /> Property Owner's Mailing Address: ►"O f 6`X S G U SI(,Vi ll W I 51-it I 1 o <br /> �. A ( III <br /> -1 City tate Zip ' <br /> Property Site Address: 29 I Via_ �%`> by- . t V( 1 Lj I D�61 2- a• <br /> i -R <br /> Contact's Telephone Number: I7 f go we- 715-.2:.2.2 -2a94' o C" <br /> a <br /> Contact's Email: A JwS (_g ( $)ra yl ie." .)9el' <br /> Legal Description of Property: tilt CD Meu r0,r)Ca oil Acs1N w -, P iL- Nh L v <br /> N 'd 1 <br /> Section#: !';y Town#: 39 N Range#: 1 Lp W Town of: VAQ,en(51(\ 0 tl° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d N3 <br /> Tax ID#(1-5 digit number; found on tax statement): I 2-1 III 1 g. <br /> Proposed Use of Structure/Addition: Je.,.,.) 1I id-t1,47 /i ,y Mee4y<s�e c� <br /> Anticipated Start Date: a. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) •� F = <br /> Building Contractor: Sewer Installer: `fY> „4 idiffel <br /> 6_ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 9-3THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 <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 for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhou es.* ro <br /> Otliee4- a U SeA -1 q <br /> Dweit Pmt- i Lee�J 3 Damvi.s Per S�� ?a 1 <br /> a0,,„d i.L4 6 ewe/ Lip -- -SII <br /> 0-,Fee Rec: �a <br /> 74 Check#: 16 a'/7 <br /> 0 <br /> p-- <br /> n' t.)t ad"S Date of staff site visit: 6 7i ZZ_ Initials f site visi a : z <br /> APPROVED BY LAND SERVICES OFFICIAL: '"� DATE: <br /> 77P0/ , <br /> 0,""v <br /> • mIiii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . <br /> G <br /> i.3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . CS C llid_ <br /> Transcendent: - Page 1 of 4 • <br /> 'Cr g , �� <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 a '” <br /> ' m M <br /> 0 <br />