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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $1111 Addition/Alteration to Accessory Structure $1500 <br /> /. Accessory Structure(Commercial/Industrial) $�4 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 .. <br /> o <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. 6' <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. , L� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. CD a <br /> Property Owner's Name: Cl i e a f" —Dc4 i.1z ' l2 ,C - C'T 1l✓1 '- &I/ 9 7c3z <br /> PropertyMailing �SZ 3'`rj (A►ca 1 Cd C a— / , y,,l- (� I ±L, 7 L o <br /> Owner's Address: alt <br /> �J City State Zip $ <br /> Property Site Address: R 3 A LO C l (C, C fit 1 .6 Ci S i 1-e t i LOT 5 41 S'7 Z .. <br /> E <br /> Contact's Telephone Number: 1( 5 - -7 9 I 9t, 7( oy <br /> Contact's Email: ..i,3 5 — S c�ln v l t Z C� Ya Gz O C co c^.-1 d l; <br /> FP <br /> Legal Description of Property: Z. <br /> NI 'o jtr- <br /> Section#: 1 3 Town#: N Range#: 17 W Town of: DoIhl t,j °_. 00 <br /> 5 6 <br /> a� <br /> *Attach additional page if needed for lengthy description OR attach a copy oft deed OR attach tax system property page.* P <br /> Tax ID#(1-5 digit number;found on tax statement): 0,0 r) <br /> X <br /> Proposed Use of Structure/Addition/ C' T c' i C C x,1.4 Ct f',Ai). t`riD1 �{pl L� 04" Sc l�'r5 1 v: <br /> Anticipated Start Date: Z y2020 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E K <br /> d <br /> Building Contractor: 4/ i1 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONIIVIENTS/CONDTTIONS ONLY , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <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 z <br /> home additions,and bunkhouses.** <br /> I Tins cr �Int— ttot A 6c, usc4 A" 4u4.'L. <br /> 6) <br /> g Fee Rec: -2 111 , 6 Act,,..e._, 1 eac../../citotit. 44/714,4,"0 4 <br /> w- <br /> 4 1/202./ . cn Check#:.--74:717 <br /> Date of staffsite visit: i/7.-.1 ' ,( Initials of site visit staff: /...--;(//7C6 a <br /> 6APPROVED BY LAND SERVICES OFFICIAL:iitDATE: J u 4 C----3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a rn <br /> C 7) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z g a <br /> Transcendent: - Page 1 of 4 t v S N <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 < 3.< c <br />