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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line s' o <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 4 <br /> 'commercial/Industrial Structure !11 Addition/Alteration to Commercial/Industrial Structure $200CD <br /> Accessory Structure(Garage,Shed,etc.) 150 Addition/Alteration to Accessory Structure $150 <br /> c .o. ur_ m= i. IN ria -•:v Addition/Alteration to Bunkhouse $150RI <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> _.,,, <br /> Driveways/&Cam o � <br /> Y / pground 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) $100ar" 6 . <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. Fo <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. �v <br /> Property Owner's Name: O/Jb'l 1J 1fI g s <br /> �y Ai - c' ° o o • <br /> Property Owner's Mailing Address: 4 '�1�0 � ��r,(���� ��t ��3� =' <br /> „* City State Zip $ <br /> Property Site Address: 64 5$ &R, . Is' r!f}/v 42 <br /> Contact's Telephone Number:30 jilt O 7 o <br /> Fo <br /> � n <br /> n <br /> Contact's Email: ,p d e I�!it�. t I o f ,y�4( is o <br /> it <br /> Legal Description of Property: Zed-- 3 6,hr-FE "c. `�/ <br /> Section#: � Town#: 7/ N Range#: 0 ao <br /> g �� W Town of: S((f G <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C7 <br /> Tax ID#(1-5 digit number; found on tax statement):.),:Loo <br /> r , 7,a X <br /> Proposed Use of Structure/Addition: / . ° - ,, ii -, _ a � Q '' ci!)-4-64' <br /> Anticipated Start Date: ( r, )r, 464.0 ( .me/ abin;Commercial Business;Bedroom;Deck; -tc.)4.1•-(�I" • o <br /> Building Contractor: E�-�v Nom, Sewer Installer: A[ d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (--, V <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed front them prior to Q <br /> AVE construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z % <br /> home additions, and bunkhou s.** z <br /> P,.e(M: 4- . r C rQoc c- Qv\ca I A I Sk-cA 3 <br /> Ak\ Sti- cj"-A`-cr5/cekr fier .f ShQ.„(5/r/o-1•- --c Au/Nam <br /> Fee Rec: /�.- <br /> v <br /> Ct Check#: 2vO7 <br /> J�� o <br /> Date of staff site vi ' '—c)-k-1 "re, 01n tials of site visit staff: ti — .k <br /> 1 z <br /> ;I r <br /> APPROVED BY LAND SERVICES OFFICI �'2'Z----"—'— TE�J----g-5----(90;)c) A <br /> . liVil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ,,W z • <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 s °� lr�r <br /> N 61.-1 <br /> ll <br /> p p C] <br /> Transcendent: - Page 1 of 4 CD .o <br /> Laserfische: ill <br /> Burnett County, WI Land Use Application— Rev 6/2020 m '�'o <br /> D J3 <br />