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LAND USE PERMIT APPLICATION — Burnett County, WI t <br /> Applicant Complete All Sections Below This Line �� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> AAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ro <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 p�� <br /> Filling/Grading $150 Boathouse $500 l� <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit squired 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. p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 1a t 1 h.{,t-- 0klx,o 0 o <br /> z r <br /> Property Owner's Mailing Address: i 01 q Aclqb. rC 1 t r C Eck Q n M Ai °oa. <br /> (�,} y State Zip v <br /> �j G <br /> Property Site Address: 3 5 �t <br /> ,-IS ch' <br /> Contact's Telephone Number: iG 12, g 12 I. '3 6 o <br /> E. <br /> Contact's Email: l Gi A Oil Y C0 eaid 1 I • e4 m d <br /> Legal Description of Property: Nei L olj e � VOe y�e/ Vr 1tale 6+v9 r <br /> 2 ��JJ ((j rr..-- o as <br /> Section#: 1 J Town#: 4 0 N Range#: 15 W Town of: JR.C,L�S '1 0 <br /> fro <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c7 <br /> 4 <br /> Tax ID#(I-5 digit number; found on tax statement): (Q (o CO(Z,) 6. <br /> Proposed Use of Structure/Addition: S�e 6( y-/ C `n <br /> Anticipated Start Date:Soon_ w G,t 4)-t ng bp. re/Ca "id;Commercial Business;Bedroom;Deck;etc.) W 0 X <br /> a d . <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: O CS3 <br /> *The applicant needs to contact their 1/DC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking p/ace for any dwellings,dwelling additions, manufactured homes,s,manufactured z <br /> home additions,and hunkhous,s.** x' , <br /> (Vie k ac( 5 k...„.., <br /> 0 0A-- r 4,4.0244 hall:bit, <br /> ✓��ee� S�J�'ce� ' ek e�ti f &15 P /5O� <br /> 6)514**c. x Fee Rec: <br /> N Check#: 1"4Z 3 <br /> c��l?��-�. to <br /> Date of staff site visit: J Initials 1 f site visit staff: tr <br /> // d <br /> y <br /> APPROVED BY LAND SERVICES OFFICIAL: A /!� DATE: l1S7?-e2 < 0- <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF 2- <br /> •-r1 W 3 — V V <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z -�° <br /> „C y n tw <br /> Do = <br /> Transcendent: Page 1 of 4 n =s <br /> LaserTische: Burnett County,WI Land Use Application— Rev 12/2020 . ? 1�s <br /> L <br />