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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> mo <br /> Applicant Complete All Sections Below This Line c'7,' <br /> o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 b <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> ‘/ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,-- 0 <br /> 150O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - r--..., 4n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t <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. CD ' <br /> -(� ll ( <br /> Property Owner's Name: 1 i T '1 n 0 Cir 0 r, /- i H.J t" a - i <br /> �p 1f o r <br /> Property Owner's Mailing Address: 3 7 6 n <br /> ) 13a �t-Q)A )-2i (C / Us I' 1, c J 8.2 0 o <br /> / /* / City State Zip <br /> Property Site Address: (? G�- r a I i = c <br /> Contact's Telephone Number: C, 0g - 7- c- 1 f1 v o - ' <br /> Contact's Email: -1—Lk ; l2 i e t' G r» a ,.1 ,. C /'V1 ,,,,, <br /> LOT 2(REC.AS 3)CSM V19 P30 d <br /> (#352307) :; <br /> Legal Description of Property: (NW NW-SEC 1&GL 1-SEC 2) <br /> N g. as <br /> 1Section#: Town#: 0 N Range#: I G W Town of: Oak I atilt. <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): 1.2 9 1 9 <br /> Proposed Use of Structure/Addition: G «V'4 4 cA <br /> Anticipated Start Date: S�1 F r,), C I (Home/Cabin;Commercial Business,,Bedroom;Deck;etc.)( \ pc, . x <br /> J t�'4.11‘Y <br /> ,-' i S( O hick YY/'\ l G Ca c(c i sz, = e <br /> Building Contractor: {M C C-1 on v''Z F� Y f Sewer Installer: )1 en.Q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v �1 <br /> **The applicant needs to contact their LDC Inspector to determine if a permit is needed from them prior to pQ <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** 70 <br /> -- ND71- 71-0 6e US I4 Ainmem AG?4f ?4 'x , <br /> Do <br /> Fee Rec: )92r� <br /> NOV - 3 2020 � L Check#: 3�3� <br /> 71°28 <br /> �m <br /> Date of staff site visit: I / Initials of site visit staff: 7; I6urnatt County I 'z <br /> Land Services Department <br /> APPROVED BY LAND SERVICES OFFICIAL: — DATE: ii /9 ZO ZO < <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> T, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 x <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 <br /> 0 <br /> v, <br /> --I <br /> a <br />