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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> • < b <br /> Applicant Complete All Sections Below This Line 0 c o <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 , <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 • r C) <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk /57,� Bunkhouse $250 r <br /> � sx 0 <br /> t Driveways/&Campground Structures — WI State Statute 59.692(1v)Structures $350 Q <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 Sr <br /> p <br /> C*NOTE:After-t e- a perms s permit aqui red after construction has begun may cost up to t ree times t e normal fee. co <br /> *Communication owers: ig - • •• -- =•- • • , - • - •• -_ • •-- - •• -•- -- .47 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: O`OQ c O1 hh 7V h e c a z i <br /> i �j o <br /> l <br /> Property Owner's Mailing Address: 1 Lit 1A-CA\I 8 e p kc1�® ka b. W t SIR) ° (D <br /> City State Zip /- <br /> Property <br /> Property Site Address: Se-1 I t ; n <br /> cp <br /> Contact's Telephone Number: 1 (S-- 661, -7n9 Jt.nix-Cr o N <br /> g. <br /> Contact's Email: o <br /> Legal Description of Property: 497 / f 04 / Ci6i114 V, V! �/5 <br /> Section#: ati Town#: CN Range#: A W Town of: C e LG,t `1 _N °0 <br /> V 0 <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): /09.J py <br /> Proposed Use of Structure/Addition: R eilmA t•/d1 ky Y'�� CA <br /> Anticipated Start Date: / o� = <br /> p (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: —.Ti)AA 1.44.-41e143104, Sewer Installer: <br /> t -a 0 <br /> AREA BELOW THIS LLNE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N R <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 then prior to A • <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured Z ( ,. <br /> home additions,and bunkhouses.** 7' {� " <br /> l)sil amass 11 RV/till/1 07 03 447 by% Z . <br /> 2) s /s an of / -- " 'd perM'%; 7. <br /> j5. Fee Rec: 1.26 <br /> K Check#: i/(47 <br /> /� /2v )J7-- <br /> / <br /> T,Date of staff site visit: /VJ/' Io Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: Liiir DATE: 0/Z7/26, Zt9 < =, <br /> F: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Fr <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 3 C <br /> ,< CD r• <br /> 0 Q C <br /> Transcendent: - Page 1 of 4 o <br /> n ' a r <br /> LLaserfische: Burnett County, WI Land Use Application—Rev 6/2020 m o <br /> c m g <br /> H • -3 <br />