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LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> ro <br /> Applicant Complete All Sections Below This Line c o <br /> Permit Types and Fees:(Please,check appropriate boxes) -- <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 = <br /> 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 <0O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse _$150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° p • <br /> 0 <br /> Filling/Grading $150 Boathouse $500 I% <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 1 <br /> cA <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 0 g <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: Raven A- Mo'5 o <br /> Mailing Arr_1 r ��orl- i - nvc_ '6rom, MN 55[ 711 o <br /> PropertyOwners Address: <br /> j City State Zip <br /> Property Site Address:l b�j �Qli?1i Or C�ravr`� t WI ,51-6 (:i v) <br /> Contact's Telephone Number: Los-1. wa5 • ioa3 <br /> �� <br /> F' , 0. <br /> N <br /> Contact's Email: iiNa rpn K inch S l�. 9 ma) i . CA ff) l d <br /> Legal Description of Property: LDt' I C;5if # 3663 Y 1 P&1 I 110V-t LO+ 3 ) co <br /> L40 o <br /> 0 <br /> Section#: Town#: N Range#: W Town of: Trail E' L. Ka <br /> S. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): a F) q J • <br /> Proposed Use of Structure/Addition: Shed <br /> Anticipated Start Date: H H <br /> p a0 (� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y �e <br /> Building Contractor: TIV.31)213 5' F i) A Sewer Installer: NAb <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 d ellin �)velliryg ga r tons manu actu_rgd.home manufactured z <br /> home addition and bunkhouses.** 'taw Vil C©' a fl d <br /> — a to tt1 5 Li f) 4tTer" <br /> �es�tore. �� n � I h�,'�lQ�1 -t, <br /> `t-f — . j f--t- Ck.- Fro(v. VP rc4%ttry,i-f)`�r1. a -e-r VI�.f i iJip (a <br /> tkum�,,� I --1-Q( S j,ore[ire lea�7`1j— be r�>/ori ma1n* <br /> 1t4l`^ ado cQ„r-• — ,-,41t-f- r 14) )(tl�eSi) ,�, <br /> \ C nP-F oc�4- <br /> � U� e�'- t�Pr� s Fee Rec: 15)— <br /> c; Sjl i ya ©Ccc�10 /' ' o Check#: 2307 <br /> Rood`� bre rthe r �f 6. ha�;.SE'�Ste �nr~,�ncN Canr�i`tios,S. <br /> tr <br /> Date of staff site visit: 0-- �a.0 Initials of site visit staff: �� <br /> z <br /> v <br /> m r <br /> APPROVED BY LAND SERVICES OFFICIAL:L:- � , �� : . . d' , CU < ��J <br /> m r- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . a <br /> � CD� - Sn? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° U Fill <br /> -�? <br /> .< n C-r, <br /> 0 0 t� <br /> Transcendent: - Page 1 of 4 G <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 , 5 <br /> ��7J, <br />