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• <br /> -o C" <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> -' N N <br /> Applicant Complete All Sections Below This Line a ;'i <br /> Permit Types and Fees:(Please,check appropriate boxes) .e Cr <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 : F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° —1 <br /> Filling/Grading $150 Boathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year 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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 <br /> �``� AC o <br /> Property Owner's Name: -TOM '� `J - R R �- �� J�' — �� z - <br /> /3?� �rThAn� +- L/L) N &an-(g vri n� <br /> Property Owner's Mailing Address: a <br /> �l City State � ��� b <br /> Property Site Address: ° cn <br /> n <br /> p �2_—'799 8�-7 ` y <br /> Contact's Telephone Number: � ° <br /> CI <br /> Contact's Email: RecA5 6 & _, /4 Ai L ` 6 VVcci -3 <br /> Legal Description of Property: L d n 1 1' c -Y&ac' LA Kc LO.+3 <br /> _r N ti <br /> Section#: I Town#: '-t( ) N Range#: L 4 W Town of: DA /)net 3. <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number;found on tax statement): /Li/3e =. <br /> r, <br /> Proposed Use of Structure/Addition: G fP e_ <br /> cn <br /> Anticipated Start Date: COPI-y Z.vZ) (Home/Cabin:Commercial Business;Bedroom:Deck;etc.) <br /> = o <br /> Building Contractor: Sewer Installer: -- <br /> S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I <br /> **Tire applicant needs to contact their L'DC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place Jroany dwellings, dwelling additions.manufactured homes, manufactured Z t <br /> home additions,and bunkhouses.** I'" <br /> V Jo-� -,r hkn r h4 bt•tc,fibi . <br /> Meed--- all 5d-bc-eks <br /> z Fee Rec: <br /> N Check#:635Mixo5,5 <br /> 6 <br /> m <br /> ? -� <br /> Date of staff site visit J�11)aI Initials of site visit staff:V,T. N.L. o <br /> r / <br /> APPROVED BY LAND SERVICES OFFICIAL:. / DATE:J/ISI / < <br /> m r- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1 -400. 1101 <br /> 41 gT ! . 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT { gcm HI <br /> Transcendent: - Page 1 of 4 s g o <br /> Burnett County,WI Land Use Application-Rev 12/2020 < a•7IV <br /> Laserfische: I <br /> OMD <br /> ro <br />