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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line a. <br /> ' W <br /> Per t Types and Fees:(Please,check appropriate boxes) °' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `, ',..1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 N.1 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° Q} <br /> Filling/Grading $150 Boathouse $500 r <br /> lii <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> C4 ID <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = i1 <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 /> Property Owner's Name: H a rt 0 L e 4- Ll 14 N (/ dl-5 e A z <br /> q A) o <br /> Property Owner's Mailing Address: a ! 3 a- lO R L1/ A V e- g • <br /> �/ r ii <br /> City State Zip $ a <br /> L <br /> Property Site Address: p -I 01 3 L a f 7 %C�L 4)w R i ell pd p 4-h d o f v cif <br /> Contact's Telephone Number: b Y 3 3) - 5.2 t15 c rk <br /> ,, <br /> Contact's Email: 5/Q vy✓t i K 51 e C d N, C Ce j 7 , h err N o ''.' <br /> Legal Description of Property: S ee © $ S h 9 0 E- o f 4►t ° J r ' o L V* , ) - L k ' <br /> N Section#: Town#: C °o N�� gig N Range#: I(0 W Town of: da,k�lan.d <br /> 5 <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.** ac Ni <br /> P g f f g Y p nn rr Y P P t1 P g p O <br /> Tax ID#(1-5 digit number;found on tax statement): I L/3 5"/ I J)- 3112.0 W <br /> Zji <br /> Proposed Use of Structure/Addition: <br /> v <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) J x <br /> Building Contractor: 5 6 l F Sewer Installer: <br /> -- SO <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY F. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 04) <br /> **The applicant needs to contact their CDC Inspector to determine if a permit is needed from them prior to CI- <br /> ANY construction taking place for any dwellings, dwelling additions.manufactured homes, manufactured z <br /> home additions, and bunkhouses.'" x <br /> -Mee-} o Stkbac S <br /> -Loc - anc c lnuCAi n ctded on SW-1-i4- Runk I i d k -i %I30/27-3 <br /> _1 k Rc) v\DA-- ko -Mad J VKd,+t om S f r K-)5-22y , Fee Rec: )Cb <br /> 0 <br /> Check#: Mg/g <br /> Date of staff site visit: "7ill)23 Initials of site visit sta ( a <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL�� � p DATE: / Z nDZ3 < ,,�U,J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c. <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z y CD <br /> ' v <br /> 0 cn o <br /> Transcendent: Page 1 of 4 corri cm <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < 1 •' <br /> b <br />