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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line „ a 2/, <br /> Permit Types and Fees:/Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 i C) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 6---'4 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Y.,— i <br /> v'P Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> � Deck/Stairs/Patio/Retaining Walt/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ? <br /> )e <br /> •••••Gradi <br /> g/ ng $150 Boathouse $500 S ', <br /> Six Month Camping Unit(One Per Year) _$100 Permit Extension(1 Year Extension-Allowed Once) $100 t <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. I <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. w <br /> -7 <br /> Property Owner's Name: i. ----- a4--i ) wl z Ilk <br /> Property Owner's Mailing Address: r ,7C1 t 1 f � Y L 1 bs' � II_t City State Zip <br /> Property Site Address: n- n <br /> vi <br /> Contact's Telephone Number: <br /> `3 Z.04030-700__ <br /> Contact's Email: 00_ V\thlYrA,i 1, <br /> il <br /> Legal Descri. '•I , Property: "S ^. (,.fj <br /> Section#: �� Town#: 3 CIN Range#: 14 W Town of: <br /> *A ttach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* d e'IN <br /> Tax ID#(1.5 digit number;found on tax statement): I Ste(Gj �,e I <br /> Proposed Use of Structure/A itio • S�e y\znaZ a �11I c) z <br /> ` c a <br /> Anticipated Start Date: ie )(�/� 1 (NomelCabin;Commercial mess;Bedroom;Deck;etc.) GII�),, <br /> Building Contractor: S.(�\ -q Sewer Installer: W <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 kj <br /> home additions,and bunkhouses.** P► <br /> O(k(eek a, ( .561C�-S , <br /> 0 Aft CICI <br /> f Ift,u6411'4ri litc, <br /> g Fee Rec: 3 OC— <br /> y64 Check#: �3'tO <br /> / 2."" <br /> Date of staff site visit: 61?Ll ` a Initials of visit: ff: '/ z <br /> i � d r <br /> APPROVED BY LAND SERVICES OFFICIAL:41 <br /> DATE: )7,,25/C:)/ , o <br /> UPON APPROVAL: APPLICA MUST POST COPY OF '% Llifiil <br /> Emco <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 c z 1 <br /> Transcendent: Page 1 of 4 (V 2 '" J <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 3 R v `�' <br />