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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> C b <br /> Applicant Complete All Sections Below This Line C1• Y ft N <br /> Permit Types and Fees:(Please,check appropriate boxes) °, y , <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 • 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ~ <br /> Driveways/&Campground Structurest <br /> 0 <br /> $125 .WI Statute 59.692(lv)Structures $350 � <br /> Filling/Grading $150 Boathouse $500 0 ••••...1%) 44` <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> v) <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. o. <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 /> %ti. , <br /> Property Owner's Name: I V 1af1L`k' I\AC tW v\it. 6004.e... ° w <br /> Property Owner's Mailing Address: �713 0 W\ Li k� Rd oth r W l I03 a <br /> /� ` I/,� /�r y City State Zip o % <br /> Property Site Address:�� 1�� OWI La�v �,i)tW14f r �i �'6; V\ <br /> Contact's Telephone Number: 61S) SDI] — 0 ) ) ` o y <br /> C <br /> Contact's Email: gDYK•e- • CA I Vl V .004611 . Com a <br /> Legal Description of Property: + I SM \) f 2OO (Go 141-3) <br /> Section#: 0(#0 Town#: 3 N Range#: S W Town of: itti 1`r�i i e ff-e- 0 . <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach <br /> a copyuof the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): -I(D rI j <q. <br /> Proposed Use of Structure/Addition: kQ ii.ekille-- ,{•i-C.df) and W basewviitunekratblh "' <br /> Anticipated Start Date: 121 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H zi <br /> x <br /> �aot �u-fs D[ �' <br /> Building Contractor: 6 k`,� �q V(A Sewer Installer: �. � ��1 t H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �_ <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 dwellings, dwelling additions, manufactured homes, manufactured z <br /> home additions, and bunkhouses.** z t <br /> I- A) f' / e c�' 3 beirooAv►S aS SAoteait ivy <br /> ‘cm 1Y-47 pe,r1A4 r 7- 5,11/11-0 r-of: <br /> x Fee Rec: .2, t'e'D <br /> Di- <br /> :4_ <br /> Check#: <br /> �' ,C,/ m <br /> Date of staff site visit: 2 3 ZO Z1 Initials of site visit staff: �/r' ///1 4 Z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: '7`�ZO Z1 < �� <br /> m <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF D a (� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° w= N <br /> Iiiiit <br /> N Q) <br /> Transcendent: - Page 1 of 4 7i <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 m go� _ ' <br /> o = OEcr <br /> a3" <br /> 3 <br />