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LAND USE PERMIT APPLICATION — Burnett County, WI C <br /> ,- -o <br /> Applicant Complete All Sections Below This Line cz <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 N <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 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 W g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 j ° mil <br /> Filling/Grading $150 Boathouse $500r �1 P <br /> o jI <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 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 /> 2 ' <br /> � 4 <br /> Property Owner's Name: , hL � <br /> 1I.,�es o c <br /> Property Owner's Mailing Address: 6Z 417 I ii:÷-'NC 5b 11/6CE VIVO 4;99 7 <br /> -7-: <br /> '� City State Zip <br /> Property Site Address: 64i1 l(1 2-10 &V) D l l t �j <br /> E ca <br /> Contact's Telephone Number: C (&IL-120- 1i- l \t\.3 (7t-Z._ Vol -Ot. o N <br /> • C <br /> Contact's Email: O e L T SCDUSI eo4'iQA.). LDWI CD dv <br /> Legal Description of Property: 1, e2t- — G I V Z, r 7(, (io h6 <br /> N - <br /> Section#: A Town#:'r N Range#: . I W Town of: ' 1NtS`E _ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> r. <br /> Tax ID#(1-5 digit number;found on tax statement): /..1 tole: <br /> Proposed Use of Structure/Additi n: Vt ' `" <br /> Anticipated Start Date: ttgl61 11,:g1) (Home.Cabin;Commercial Business:Bedroom;Deck;etc.) o to X <br /> 3 � <br /> Building Contractor: -- Sewer Installer: niAr <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> °*fhe applicant needs to contact their t,DC Inspector to determine if' a permit is needed from then prior to c <br /> I:VY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z aQ <br /> home additions,and bunkhouses.** x <br /> Cm c. steer fNk- k 60)1ileeted 71-o <br /> Tecf---i-c Ste ti (Re CO/Yl?eci- 'QCT f F � pit/lent <br /> .) <br /> x Fee Rec:1��� <br /> L4 Check#: Ji7 7 <br /> e <br /> Date of staff site visit: /6— 0---(906)'C) Initials of site visit staff: 1\M) rriz <br /> 0 <br /> tA <br /> APPROVED BY LAND SERVICES OFFICIAL: L 0 0, AI i • : it i/ ��;_o < �� <br /> ,.., r- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r±i 2 G <br /> -h s. _ —1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 y <br /> O 0 <br /> IN, <br /> Transcendent: Page 1 of 4 K <br /> Laserfische: Burnett County, WI Land Use Application- Rev 6/2020 < 3 C.:.) <br /> rn CD <br /> 0 = _ <br /> a <br /> 3 <br /> -o <br />