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a- 1 ro r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> z v <br /> J f <br /> _ Applicant Complete All Sections Below This Line i o <br /> Permit Types and Fees:(Please,check appropriate boxes) - `� 1 <br /> a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200jj { !y <br /> I <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 , <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ( ? i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(Iv)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r \j <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 7. i 3 <br /> r <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. S <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. f <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. \j <br /> LA <br /> r� / L r- r- <br /> Property Owner's Name: L 1 r4(1 (, >n (e- I t ie GI � P✓'! n&v5htty. 1 �' <br /> �/� f,, ,�� II nC <br /> Property Owner's Mailine s d-:ss: 5T1 kv(� S r Y\_- __--�_��� M1v 55"3r o i p <br /> AAAL, ( City State Zip i, <br /> Property Site Address: J]' _ O1X) 1 I"I A , / vr' <br /> Contact's Telephone Number: (o ,9I 6;91 U a <br /> = I. <br /> Eri <br /> r <br /> nn � a <br /> Contact's Email: quid n(Jn�L V �,Q` • cjw�1 <br /> Legal Description of Property: <br /> • o w <br /> Section#: Town#: N Range#: W Town of: fat _ 1 Qt fl 5 P1!P I <br /> ti-D7 <br /> OS <br /> *Attach additional page i/needed for lengthy description OR attach a copy of the deed OR attach tar system proper•tt.page.* <br /> Tax ID#(1-5 digit number; found on tax statement): /lima* 1�1 8E. <br /> Proposed Use of Structure/Addition: 6 Ie--aL c*-ems/ cr <br /> t <br /> Anticipated Start Date: IQ I I 1 go p (Noe/Cab 7/ <br /> :Commercial Bu.,....................., ..,,,,..,« t 1 s <br /> a m <br /> Building Contractor: J QC,k1 Lj h.Giy VC ✓t Sewer Installer: 14— tA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,j <br /> **The applicant needs to contact their IDC Inspector to determine if a permit is needed from them prior to IN <br /> ANY construction taking place far any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** 1Notxl <br /> ✓ �urna✓I b/ 7Iov \ <br /> 1 <br /> Fee Ree: 5b <br /> zz <br /> Check#: <br /> Date of staff site visite 7 ' 'C) - 1nitiaIs of site visit staff: AY- ,.. <br /> ,_ <br /> 7 <br /> iwi,.)...zY---C-5---N—MATE: <br /> v r <br /> APPROVED BY LAND SERVICES OFFICIAL: /0 7c') <br /> F r <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF E'2, m T m::51 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . y o <br /> o a ry Transcendent: - Page 1 of 4 'K .Burnett County, WI Land Use Application—Rev 6/2020 <br /> Lascrfische: m <br />