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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a g, b <br /> N .r 1 <br /> Applicant Complete All Sections Below This Line N a N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 =~ 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 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 -9 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 }J <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 a <br /> Filling/Grading $150 Boathouse $500 o <br /> 11 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. F. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. " t-'" <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r— <br /> Property Owner's Name: j b(\ - 3 t` \ ?..):)c)11� z <br /> �� y.2 ,� P <br /> Property Owner's Mailing Address:�gc,ZCO bc-v\ f\i 150-N Kul.- <br /> -_--.- <br /> C.�\lDe( Q . oo <br /> City Stake Zip b <br /> Property Site Address: S CCI1r\$_ CSS 0,ko00 Q_ a , <br /> K V <br /> ] <br /> Contact's Telephone Number: k a .act hi • (.D 5 1 s (c) ()Ls t -•-os3 ,i3Q0 <br /> Contact's Email:_) L J N'‘�'J jl)( CCD (7) r\C-1C�;\ . Ur\/-\ o <br /> Legal Description of Property: A �-�-- , '�f 1. 1 P (2 f`Z.r ��0� I -� <br /> �1 N <br /> Z 3 Town#: 7 e9 N Range#: �� W Town of: le C:`�- ❑ <br /> Section i; ` 1 0 <br /> *..l Cinch additional page ifneeded,/or description OR attach a copy ofthe deed d R attach tax system property a e.' va <br /> 1 lengthyR R P YR g� d <br /> Tax ID P(1-5 digit number;found on tax statement): 1 3 S t1)9 R. <br /> Proposed Use of Structudd nc-: Oc(�L C H H <br /> Anticipated Start Date: jle/A1 P (Home/Cabin:Commercial Business:Bedroom;Deck:etc.) °3/0 y x <br /> i _q e <br /> Building Contractor:l.D C c 4 �j1eI Sewer Installer: C\ <br /> ' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <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,andtbunkhouses/ T;/I** ,� xi <br /> ,,0 <br /> ©I me-t- 4 Q e.. L4 e ' ^ A 1,/IM A K Ace b/'/C777e n <br /> /✓I d/ e, su 749 iq-u/- ./t res/7" s Ahok (Al es7' <br /> , ) <br /> /V I A f N 1"e— pv1 ee /0 1 S/ s cI•C /(/e N f 6u x Fee Rec: _� <br /> 410 o I <br /> 5- Check#: I h9 <br /> ilvie- <br /> Date of st f site visit: �Z�o/7.0 al Initials of site visit staff: )ft <br /> /1 //1 Z/ <br /> �/20Z/ ` � <br /> APPROVED BY LAND SERVICES OFFICIAL: ___,•—•-___,•—•-..._ -� DATE: �� � <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF a a -1-1 Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT co <br /> ° m 0 N <br /> . w W <br /> Transcendent: Page 1 of 4 m o e° r.,) <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 0 3 QC <br />