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LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> Applicant Complete All Sections Below This Line c <br /> J RJ <br /> Permit Types and Fees:(Please,check appropriate boxes) i . <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ^v! <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ,� A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cd <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 2. k i <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. n <br /> r- 3 <br /> Property Owner's Name(fir'\CL SV-10\\,..\ <br /> Gr'c * v-'\ o <br /> Property Owner's Mailing Address:l.ollo2 'A y jvO.._ dl b" T L - C <br /> (�,,.� City `1m State Zi <br /> Property Site Address:(Q1L.DZ M r ink. LardtnCj I WC. as3L) <br /> I � <br /> Contact's Telephone Number:—/ •q--72_. l0 2.5 .717 <br /> ��v� �� C�� �C..crr- ° <br /> Contact's Email: 1-7 F <br /> Legal Description of Property: Pka.4100.-Se---- <br /> Section#: Town#: N Range#: W Town of: t SSa6 NN <br /> 5' <br /> tio <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): 2� 2 a. <br /> Proposed Use of Structure/Addition: <br /> ' A 1 -� <br /> Anticipated Start Date: [ `1L �_ (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) ` l p H <br /> ° H <br /> 1" ° <br /> Building Contractor: n1C".—. 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 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 bunkhouses.** x <br /> Os (Ylee at( S a <br /> p5o <br /> 4. r hwnccn `6,4m4iceel <br /> k 4,01 av p( i€ds +0 be 0104 -}tv mewl to 4- <br /> b (� //l7d. = Fee Rec._L <br /> e. <br /> St55€4194 tl�'l ! s <br /> Check#. SLID <br /> rrl <br /> Date of staff site visit: 7/Idt( ?)-7/120 I ' ir. <br /> als of to visit stat: • • } V ' Z <br /> 4 A _ - <br /> APPROVED BY LAND SERVICES OFFICIAL: /� �,/�- DATE: /2?/aQ� <br /> A <br /> G <br /> i i F <br /> UPON APPROVAL: APPLICAN= , UST POST COPY OF Dm i Big <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a <br /> Transcendent: Page 1 of 4 m n I= <br /> Burnett County, WI Land Use Application—Rev 12/2020 m ; g <br /> Laserfische: m <br /> 1Ifil <br /> m <br /> K <br /> �L-•- •+.J <br />