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* LAND USE PERMIT APPLICATION — Burnett County, WI a @ <br /> Applicant Complete All Sections Below This Line 0. <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a, U <br /> d \ <br /> X( Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `4 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `J,z, <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 o N <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 — rn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. E. <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 /> p o <br /> Property Owner's Name: S `�?E AI 4H t>� �(AA i z 1. <br /> 0 lb <br /> Property Owner's Mailing Address: 6330 Of tIt t)014\t taAKl: fv--pi mo1/431-4 NI(1.) 5LW1 I N.1..: y <br /> / Citi State Zip $ L <br /> Property Site Address: 3 5p eNwi nrSO\A MiWe. _C4Z kA)--t- 5�,�'3�.3 E. <br /> Q <br /> Contact's Telephone Number:' � z1�D <br /> � Sv2S <br /> 20 5 ' b�?" Z 3 o <br /> ti <br /> Contact's Email: 'b NA A • t?el'CQSOLJ W I @ 30\A -�� 0 4 0 � ' eCD <br /> • <br /> 0 <br /> l.O� -1 -� M t1I95 9ou <br /> Legal Description of Property: � G i� J� ► LaL <br /> N ro .D <br /> Section#: 3E) Town#: AD N Range#: lb W Town of: J AL' S 0 pV °_ Q <br /> 5 <br /> CFC*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa e.* <br /> P N <br /> Tax ID#(1-5 digit number;found on tax statement): b 1 a 8 C Da.) i V <br /> Proposed Use of Structure/Addition: L 1A4i\ `� <br /> Anticipated Start Date: S e.Vt \S 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ok <br /> Building Contractor: •?e-,tiNm, LOv-Si Sewer Installer: NOl* ti.S / 1ct‘11/4.goo , 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Q 6- <br /> THIS <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ^ µ� <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 1 j l.; <br /> 09 <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z r <br /> home additions,and bunkhouses.** f S <br /> d (Kee* 0(.11 54-b4c <br /> 0 e(( ' (loci- e)(Cees 3 bee(reofrs Pd <br /> Qteiv- , -��� ✓►QdS S�,.r e w 1 �eed <br /> Fee Rec: — <br /> (:)‘„,)4 A%4)aelsoM ` V.). Check#1,00.114 <br /> o <br /> Date of staff site visit: Initi s of to visit staff: ' a <br /> / /��� q CD <br /> APPROVED BY LAND SERVICES OFFICIAL: V so <br /> /j DATE: `/10/t 1 �r <br /> UPON APPROVAL: APPLICA► '.►r UST POST COPY OF S©OW? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT • o o <br /> co c r..1 <br /> Transcendent: - Page 1 of 4 ; K <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020P j[1( <br /> l_ J <br />