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LAND USE PERMIT APPLICATION -Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) °. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <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 r 0 <br /> / Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 54 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° D <br /> Filling/Grading $150 Boathouse $500 <br /> A <br /> a <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. p <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. l' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> rg (- <br /> Property Owner's Name:LA,'/A14- /ce X,e r_.:7- a o , <br /> Property Owner's Mailing Address:gip /2., •J CDS/ C, 2.0 LE S (,j yE is,it �'(,v f3 /b g <br /> 77 City State Zip <br /> Property Site Address: �9 05 AAA/grimy 72 y L�J ''- f l✓E tlj I.� <br /> q e i v, <br /> s� v <br /> Contact's Telephone Number: 7/5 - q 7'7- a.-95 o N <br /> �) a. <br /> Contact's Email: ( �)/t/t/....4....A:c/Q1,•eati7 d <br /> d <br /> 5 <br /> Legal Description of Property: 56E /47174z° i74L°jf ., <br /> N ro <br /> Section#: Town#: N Range#: W Town of: =. 00 <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> a <br /> y <br /> Tax ID#(1-5 digit number; found on tax statement): 2-2-93 / <br /> Proposed Use of Structure/Addition: 5-1;, 466 /— r" <br /> H -i <br /> Anticipated Start Date: 9_ fi ,„to •-1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor-it/74- Pe.e.,e- //,q/pyvittt`4�grSewer Installer: ,r//e) t7 <br /> r <br /> ti <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY SU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: cA (J/ <br /> **The applicant needs to contact their GDC Inspector to determine if a permit is needed from them prior to "J) VO <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z -� <br /> home additions,and bunkhous s.** %n <br /> i l�►'1� o S�--b4 S. . <br /> r h"�an �i.br'4t. orI <br /> Sh .., <br /> e loxia) Nees ✓nee+ qll Se.�v . <br /> Fee Rec: (.5b - <br /> 5 Check#:1545 <br /> Date of staff site visit: 1e i I 1._ <br /> Initials 1 f site visit staff: �/— _ 61z <br /> CD0 <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL / DATE: `/1312 ( r a D <br /> UPON APPROVAL: APPLI ST POST COPY OF 4 S G' <br /> a Ecow ififil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r 0 N o <br /> '< w.c N <br /> Transcendent: Page 1 of 4 3 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 2 = ll �►u <br /> o `c:7=a% <br /> cn <br /> a <br /> a <br /> b <br />