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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> c . <br /> .; N <br /> Applicant Complete All Sections Below This Line oo <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) 4. °' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d �1 <br /> CCD <br /> ommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ^.1 bYn <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> M a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 _�( :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 " F14?,,, <br /> G"" <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 c ilk <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired 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. <br /> *Items not listed above will be tredted as accessory structures,such as:pergolas,landscaping,etc. / <br /> Property Owner's Name: (624-?r ' --/- �,// e"r y / 2.. / F-/l In S' I, ) . <br /> c 4 n � '; <br /> Property Owner's Mailing Address: �l 1-��ST'l /��h �tc y., � G✓.L S 5��'3c> a. <br /> City /_ State Zip i <br /> EK 1. <br /> Property Site Address: 9 d Cad / _/'ST P4-, i el r/ /tet - yea e) . I. <br /> �/J — 7 fc <br /> Contact's Telephone Number:_ / "' � 7 7 � _ o G <br /> Contact's Email: � l Y—/1// ri S /47V6-- C) 6 iz' , I , C 6' - 0 n <br /> Legal Description of Property:A v7 7 G-si1 1,./,„ ‘ P3 / ...G.Z. �) <br /> / 9 / a ao <br /> Section#: Town#: I/0 N Range#: /6' W Town of: Oso-/(/4 vt e/ c <br /> 5' <br /> ao <br /> *.Attach additional page il neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): . ' "-V7 6" <br /> cn <br /> Proposed Use of St ucture/A iti : 711t)t)141 H <br /> Start Date:c9/f (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> E, <br /> Building Contractor:/44 r-7~ e,-_- IL /Y/co 4 Sewer Installer: fiv//am TS�r2-i( <br /> �LC H <br /> C <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 In to determine if a permit is needed from them prior to <br /> ANY construction faking place for any dwellings,dwelling additions,manufactured homes,manufactured 2 �Q <br /> home additions,and burtkhotcses.** 4� �. e S <br /> 1 4 k --\---\\e_ 10 <br /> s Stc2 < ei-los „6 Andcw&er-S ihgrki et) <br /> Fee Rec: <br /> Check#: <br /> Date of staff site visit: '�� iitials of site visit staff: a <br /> incira <br /> rri <br /> ci <br /> rn <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: 7—D c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y i ° i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 11 NITN <br /> Transcendent: - _ Page 1 of 4N.>Lasertische: Burnett County, WI Land Use Application —Rev 6/2020 r <br /> e <br /> y Uuu <br /> L J <br />