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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line _ _ 0 ,� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 '. .4:114.°Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250, n v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 0 r <br /> Filling /Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v b <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. W ,,a► <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,� <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: } 1V1`rvi,vvt Ayak A Cllr k-g-ese. of,-) _ o x '♦ <br /> 1p333 Ci;tit d_�1 ._ 1e}J 12,6 171.C1 e id M A 5123 o I c>► <br /> PropertyOwner's MailingAddress: _ <br /> `� City State Zip d �' <br /> Property Site Address:SH�L1 WI A. (oyi . 1( i v-cos-f---ev r vVJ- <br /> DT <br /> Contact's Telephone Number: J117- 201 -(I 7`- "' <br /> Contact's Email: Pr lq -.2 I-7 Q liof-r'��!li1 (ovvi a <br /> 1111 <br /> l.1A V , vV v1T S L�)+C- i .' ItI j IN o <br /> Legal Description of Property: '� '� <br /> Section#:'j 1, Town#: I-11 D N Range#: Q (1 W Town of: LA i/1% U✓I 0 <br /> *Attach additional page if needed fur lengthy description OR attach a copy of the deed OR attach lax system property page.* p <br /> Tax iD#(1-5 digit number; found on tax statement): 2,5`lN' <br /> Proposed Use of Structure/Addition: f-t O'n"1 <br /> -t <br /> Anticipated Start Date:01 - I I -20 2.0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 k <br /> Building Contractor:RAV..e 4v18-e X1 rl Sewer Installer: HG7 'v--t it cj -1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY LI\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ! <br /> `"Il;t'applicant Creeds to contact their 1-PC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place fir any dwellings, dwelling additions, manufactured houses, manufactured , z <br /> home ttcltlitions,and bttnkltuuses ",: z <br /> > -1-11-1 s pe rim---f— RQ v Sect /O-'3 a -oZo, -O. <br /> ----7per v o -&s s rte' 4-Q /s% ( '17-4 rano ' -( Cr76 <br /> 5ctnr00m f cy'ass elr;✓QLtiat y. <br /> bu J�� t��a I _ Fee Fee Rec: <br /> > cStAA roow• ('d be fem.a�/ed .J �( <br /> Check#: 132,; <br /> --., _-�. �`` a / ° With to 42", ,re <br /> Date of stalT site visit rw 67> Initials of site visit staff: ,j°,m� z O Cfse <br /> J! EDBYND SERVICES OFFICIAL: >, _ r TE: —L ..c <br /> cn UPON APPROVAL: APPLICANT MUST POST COPY OF Q X.›. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? g. <br /> Qo a <br /> Transcendent: Page 1 of 4 m-3 a <br /> Burnett County, WI Land Use Application —Rev 6/2020 , ` <br /> r,-1i <br /> Laserfische: <br />