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CA 'CF r <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' c <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> - C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?; W <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 �O <br /> AccessoryStructure(Commercial/Industrial) 'Q o <br /> $200 Addition/Alteration to Bunkhouse $150 ti <br /> 5.1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> in Unit(One Per Year ° <br /> Six Month Camping g ) $100 Permit Extension(lYear Extension-Allowed Once) $100 <br /> K 6 <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. �d ; .,o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -o A <br /> Property Owner's Name: V/.,e.-47)y/IA Q7' i/'u Kj ri 9., z <br /> i�l , n j, SSI I ~n lr <br /> Property Owner's Mailing Address: LV, �kJ.Q,Set" v e,,,.) ,I l y-, Sr. teut ,ASS") <br /> 0lA <br /> 4.1„..., <br /> Ci_444 1_ TState7 i Z� -o . , <br /> Property Site Address: 5 S / t = r)r <br /> Contact's Telephone Number: i - i S gel '�+- 0 _ X <br /> Contact's Email: V i '_1 vV 1.✓_-Q �/S I m K I✓�S , 60 ik \ c i <br /> Legal Description of Property: 'f N b <br /> Section#: CP Town#: 41 N Range#: !4o IA) W Town of: Ca K /441 e ° °0 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> 1 CA <br /> Proposed Use of Structure/Addition: S tDV a Cj A. SA e j <br /> J H ^i <br /> Anticipated Start Date: <br /> /n� "1- 1G -- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o k <br /> Building Contractor: C'�-eorj r-rl elf's Sewer Installer: Nf 4 <br /> -s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d <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 front them prior to <br /> ANT construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z <br /> home additions, and bunkhouses.** ( i Aaii,liiiN <br /> At- RV-- Ril' il <br /> Fee Rec: lea`° <br /> a <br /> Check#3-4033 <br /> Date of staff site visit: " �' 0 ej In . sofsite visit staff: �� �J <br /> /7---- <br /> w <br /> APPROVED BY LAND SERVICES OFFICIAL DATE:? —3—� 16—a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF `,. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 'o N <br /> f-1.,'.< o Q <br /> Transcendent: Page 1 of 4 o <br /> Laserfische: iliiii <br /> Burnett County, WI Land Use Application— Rev 6/2020 m <br /> JJ <br /> D <br /> 3 <br />