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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> E. N N <br /> Applicant Complete All Sections Below This Line ° c <br /> CD I-` <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ;; <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 —..„„,.... „ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� k <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o 6.U)c <br /> Filling/Grading $150 Boathouse $500 t <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn "fry— <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. go <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a <br /> \ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i <br /> Property Owner's Name: l� vtv� 4 @NILi 1- s vYi 0 o <br /> Property Owner's Mailing Address: 3C(3a 0lnv,,v,c.. . LJLQ C S;r W15cl 7Z o <br /> City State Zip -a II <br /> Property Site Address: 2300( Ovu.i.0 Lc Ra `7;v-C-. L%).L- $/ 7 2 ET O <br /> Contact's Telephone Number: Col 1 " U( - -a-7 5 If o <br /> • c <br /> G i ` <br /> Contact's Email: p�((vim),C}1.�„,S vr,Cp /�o �c t v�.c ( c .17> d <br /> w <br /> Legal Description of Property: (c-1- I C 5t1A `I`fi 5-1101 01 b P 10C.) R 4 0 y ca 55 `I (ht Sw <br /> p n o oro <br /> Section#: d g Town#: :5F N Range#: I 1 W Town of: DG.h, 414- __ <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Fs <br /> Tax ID#(1-5 digit number; found on tax statement): 3 5, 3 3(o n• <br /> Proposed Use of Structure/Addition: ?U le 6 to ((I,.. cn <br /> o v <br /> Anticipated Start Date: Co as (Hom2 abin;Commercial Business;Bedroom;Deck;etc.) <br /> .93 = v <br /> Building Contractor: Sewer Installer:01.4 T`,-- I for <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 16 01 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 . \S"1 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to (IC <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions and bunkhouse . * <br /> 1 (V!ees�' 4,1I Seo-Il, <br /> NOA- >V ti ,,,Irna.r kAiDArci;on <br /> 00, <br /> z Fee Rec: I <br /> y Check#: <br /> „T_47_o <br /> ro <br /> Date of staff site visit: 149/271 2'1 Initial o .ite visit staff a. <br /> z <br /> v • <br /> / rn <br /> APPROVED BY LAND SERVICES OFFICIAL: �� - DATE: 1I/'l?/ < r <br /> /� m a C:) <br /> T <br /> UPON APPROVAL: APPLIC A = MUST POST COPY OF m o �' *0 <br /> o 3 0 -� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z a o <br /> A 'A•< N <br /> Transcendent: Page 1 of 4 m <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 t f <br /> m <br /> v �a � <br /> E <br />