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t. <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a : <br /> Applicant Complete All Sections Below This Line o' C t <br /> Permit Types and Fees:(Please,check appropriate boxes) ii <br /> v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <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 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 PO <br /> In <br /> Filling/Grading $150 Boathouse $500 �A <br /> Permit Extension(1 Year Extension-Allowed Once) _$100 a <br /> *NOTE:After-the-fact permits(permit aqui red 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. o I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> .akProperty Owner's Name: ' r �' i <br /> Property Owner's Mailing Address: <br /> 0� AL.r-ch, amply,A,,,,4 m f ss--11 1 4 <br /> Property Site Address: I 1 �p Lig ThQSc L( \ A p, j 1..1.L-K L,JlZ SI i State3Zip o 1 %. <br /> 1C3 a <br /> Contact's Telephone Number: 10 f, 1p a R ( 4--, Er tJ ', c <br /> Contact's Email: ex 4 1 w e%d )ksmk\ l 4 C6Y\ N '4:7 r <br /> . . <br /> Legal Description of Property: <br /> Section#: Town#:-Al Range#: i b W Town of:littth L -�_ � a 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* • <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): x.361?7 Ni '-3 <br /> Proposed Use of Structure/Addition: Ca�,�Q <br /> ' <br /> "c. <br /> Anticipated Start Date: " V aaaa (Home/Cabin;Commercial Business;Bedroom;Deck.,etc.) I y n ` <br /> Building Contractor: 0(4Q,.r Sewer Installer: N �J - W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant steeds to contact their UDC Inspector to determine if a permit is needed from thew print.to <br /> v <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,mantfactureti J Q1 <br /> home additions,and bunkhouses.** L <br /> ' $ E.1I� was afire,uld V19R 2a-OZ, ,^- tC' <br /> T�I S r 1 per Q <br /> �Kd 61611' 1°1 litarq prf / � w►usf- 6e.. n ^�� <br /> AFI I 2ND Al4NAAP1 kit 6r' �r®h, old° tel• A <br /> -F�/lows60 <br /> Date of staff site visit: Initials of site visit staff: m C IV Rec: ' <br /> 0E:114 <br /> NvZ P IIN;-ck#:APPROVED BY LAND SERVICES OFFICIAL: DA <br /> e � , <br /> UPON APPROVAL: APPLICANT MUST POST CO `� <br /> a <br />