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• LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 3= o <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> W <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) - <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < O 1. <br /> Filling/Grading $150 Boathouse $500 r <br /> Per Year) ^ <br /> Six Month Camping <br /> p g Unit(One $100 Permit Extension(lYear Extension-Allowed Once) $100 D-- <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 0 a vt ,,A R L i I . (old c v., Fru y\.c rS D k i l s o r\ ° z r <br /> Property Owner's MailingAddress: a� ll-� C7 ✓1 1c-- 'F'-ede tlg. 1,vi 5483 c ��; <br /> P Y �� 1� �S G o <br /> p e City State Zi -a <br /> Property Site Address: O d h S vtn >tr �C' f r_ j S gj <br /> Contact's Telephone Number: S 1.: Sq.() _ 5A b9 o y r�i <br /> Contact's Email: ) j S 01(\01(\ c� 0 �/G k oo•Ld►M o 2. O <br /> \A) <br /> Legal Description of Property: L.t c, 041 Lr a (r L)0/u Me - I VI ro <br /> i N as <br /> Section#: 3C Town#: 3? N Range#: iS W Town of: 1.a Fo lie il e C <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> 4. <br /> Tax ID#(1-5 digit number;found on tax statement): 10177 <br /> Proposed Use of Structur Addition: G cicq ci ,e <br /> Anticipated Start Date: .,�(y\.r a.0. , I Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: Ni o A- e ("0 C e r Sewer Installer: 10/ <br /> -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a\ — <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured <br /> home additions, and bunkhouses.** z <br /> G/ar4pe: rt'/ 74, de.. us/� 1 V I�ut...tLQ 11a�l/d// bion . C1 <br /> — $c.e /a4 TYn wt- N e.,:,4 L e i,- 9 S ri'YT /4/S ci f,O YD V c / <br /> Se-e ems .e,4- loc. # 1,631/2.9, l c� <br /> =M--- , Fee Rec. <br /> C <br /> Date of staff site visit: Initials of site visit staff: zCheck#: <br /> OP Add. u <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: Am& DATE: /0// � <br /> O < r <br /> rn <br /> Ififil <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF ID� r-13 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° NIiiiii 0 00 <br /> -C 0 c N <br /> Transcendent: Page 1 of 4 m,w c r Q <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 n,. <br /> (C_�_) <br /> C <br />