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LAND USE PERMIT APPLICATION — Burnett County,WI C/) <br /> g <br /> ro <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,,5' <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 ,.. ' I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 rl 4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 "� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ? �' <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 X Permit Extension(1 Year Extension-Allowed Once) $100 111 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g I <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc - <br /> g 'fir- <br /> Property Owner's Name: 11--,c 4 rH n : ( f'r2.r.-fr R t, -e1 k -viI-z o <br /> Property Owner's Mailing Address: 9 S ilia 14l1 get re. A oa d Dothan' or <br /> City State Zip ' <br /> Property Site Address: o?g //(2. kt'lkac ' AOa d 6.4/R3 O g. r) <br /> E <br /> Contact's Telephone Number: i 1 S - 55 b - 0 3 717/ (lea HI) '7/' - 55 6 -l�ev341 o <br /> // (Gr^ant> n. <br /> Contact's Email: kr a eq r1 r-4-2. G` 9`v-u 2 i/ • Cc'M d <br /> lI °' 1 <br /> Legal Description of Property: 'i'l'lot± P,-i—of 2-04- / (s5,-1 ✓3 P a DPSC 634/6TA —Fo' 'I <br /> N -o 7 <br /> Section#: l 3 Town#: 1/C' N Range#: / 5 W Town of: c a C k5 Pr) °_ °O <br /> °Q <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> P. { ` <br /> Tax ID#(1-5 digit number;found on tax statement): 5 a 81 ...,. <br /> 1 ' <br /> Proposed Use of Structure/Addition: /-ll'6m e t' Gar- -q e cA <br /> Anticipated Start Date: f a I I -� <br /> p' Go o?O (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � <br /> Building Contractor: Jake ,/1,errt-+f Sewer Installer: — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY R cii <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 93 <br /> ...r.-The applicant needs to contact their I'DC Inspector to determine if a permit is needed from them prior to C.6 <br /> ,tvy construction taking place for any dwellings, dwelling additions,manufactured homes, numufitctured z O <br /> home additions, and bunkhouses.** Pc 3 <br /> 0.:' <r- ,/ per, _ + WP- 19_L/L O <br /> x Fee Rec: t,(i <br /> z Check#: <br /> _� d <br /> Date of staff site visit: Initials of site visit staff: <br /> t-. ' ...,._c___JD <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL \(-"- DATE: / / --c)-0--az < ;- <br /> DATE: RI <br /> no. , <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a u U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zRI <br /> oo <br /> m - <br /> Transcendent: - Page 1 of 4 m 3 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 (-) <br /> _ f� <br /> L J <br /> b <br />