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w r- <br /> LAND USE PERMIT APPLICATION —Burnett County, WI j <br /> <7. b <br /> Applicant Complete All Sections Below This Line s <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> a , <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 i I d <br /> Commercial/Industrial Structure 1$300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 : 5' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 j <br /> rt <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 'V j <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' o 7"\ \ <br /> Filling/Grading $150 Boathouse $500 1 b 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 1 <br /> 3 m <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. , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> le <br /> Property Owner's Name: ' O"��S r DO - {N'i � z <br /> P ,. 44 x <br /> Property Owner's Mailing Address:Aa5b 2�\c,\----\‘ l to x" <br /> -} 4 ty State Zip <br /> Property Site Address: D N.2 C urV p60 hof l.V S L(301 <br /> i k Zie. - <br /> Contact's Telephone Number: \s,ta -j) — .c)c\' o y ± , <br /> G. <br /> Contact's Email: i k� Y�v Cl V����:�G L C_� �Y� <br /> Legal Description of Property: .l'`Q2_ke, c��CQ-S Q;,,Nc� �,.ry A ' (s0 , . \v'Ns - <br /> Section#: Town#: N Range#: W Town of: 0.,,,,,o, c....( -k X00 <br /> g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ti <br /> Tax ID#(1-5 digit number,found on tax statement): 190 <br /> !a p t 7 0' <br /> Proposed Use of Structure/Addition: :r .p�� <br /> ��7 �.J p y <br /> Anticipated Start Date:Wvx �.v ir\ 2°Z...-\ INome/Cabin:Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:-J-0(Nv-N `...51/411:-.)1/-\5 Sewer Installer: 1W y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i I C <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 {.0 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bN No-i- unkhouses.**i `n ,�� , L I <br /> eliciatiel <br /> ci <br /> cc-c70-4-pr: <br /> �c <br /> r l�.c �wnc�,n, <br /> t <br /> Fee Rec: <br /> � � <br /> (:)...,1� 64 Check#: -7 D 3.., <br /> 2 <br /> Date of staff site visit: ' ` Inti• of s' • visitA a <br /> APPROVED BY LAND SERVICES OFFICIAL: sit__,A ��,�% DATE: 6/c2�7 < ,_ JC ) <br /> /g//" a. <br /> UPON APPROVAL: APPLICAN r ST POST COPY OF a I i 3:Pa <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 g <br /> C <br /> Transcendent: - Page 1 of 4 2 CD <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 t <br /> 0 L <br />