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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 5� c '` <br /> Permit Types and Fees:(Please,check appropriate boxes) ° ..i1 <br /> Dwelling/Principal Structure $300 1/Addition/Alteration to Dwelling/Principal Structure $200 g <br /> bel <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $3501 <br /> ri <br /> Filling/Grading $150 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100_ Permit Extension(1 Year Extension-Allowed Once) $100 <br /> Co <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. c. <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 /> r, 1. C <br /> Property Owner's Name: brr. - Tc mei S 2 t Sc,✓j`1c-L a: ( C. I Z c <br /> Property Owner's Mailing Address: r. (,'cam f O:f 1 (N6 11S-We 6-;"�6 CE i (�.� <br /> _ City State Zip ' 9J <br /> Property Site Address: r {C7 c, S i i e r . I.)OOCG.1-[-(c', (. t. .M` <br /> Contact's Telephone Number: COS I-Ll ifS-3(o'er?__ r A <br /> Ca. <br /> Contact's Email: Sif.ew-v..t.lUGC2,S �S x/G Ltc,o CZ r'' ' e <br /> Legal Description of Property: 1-(71-,5" CSM ✓(20?g I I N e Al If) .. k <br /> N <br /> F° <br /> Section#: agl Town#:39 Al N Range#: I (pt.J W Town of: pprt� D <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* G <br /> Tax ID#(1-5 digit number;found on tax statement): 1,9 iS Z <br /> Proposed Use of Structure/Addition: RioOlke t GCY&1;oe r1/4-04- ZOSIJc rv.1 OOeak Co <br /> H H <br /> Anticipated Start Date: 60- I- 20 Z.I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 ' <br /> (941S-tarY� ) <br /> Building Contractor(jC:�r47r CUr1S{{c.C-V,un. Sewer Installer: �4t&�v�Sil0 i inn V.1 <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t� C.n <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 Q <br /> home additions,and bunkhous s.** %° <br /> 0 mem- J 5e f-b k <br /> 0 D we ,n c Jr .occe ee( beerloofrl <br /> 0 loc,V } c 4J n neekS 04 50-1-) +n k5 0///24 <br /> Fee Rec:'='110 W <br /> I R. Check#: C0�� <br /> 6/111 la m <br /> Date of staff site visit: Initials o .ite visit staff. <br /> ez <br /> APPROVED BY LAND SERVICES OFFICIAL: , ,/ // DATE: 6//5/2 / <br /> < . .___,c,i.J-3 <br /> UPON APPROVAL: APPLICANT" ST POST COPY OF y „- <br /> UPON <br /> TT c 0 <br /> 11 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 -,3 o <br /> w n -► <br /> Transcendent: - Page 1 of 4 ccil 2 N <br /> Burnett County,WI Land Use Application-Rev 12/2020 <br /> h <br /> .< Q <br /> Laserfische: - <br /> Ii+u <br /> i Lc—"--;J <br />