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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> ot <br /> e. �. b <br /> Applicant Complete All Sections Below This Line o" o <br /> Permit Types and Fees:(Please,check appropriate boxes) a• <br /> welling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure <br /> $300 Addition/Alteration to Commercial/Industrial Structure $200 J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150eD <br /> O <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 <br /> Filling/Grading $150 Boathouse $500 <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 'OP <br /> *NOTE:After-the-factpermits C4 <br /> (permit squired after construction has begun)may cost up to three times the normal fee. CO <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. E. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> co <br /> y biot')L i LC..C.d - 4 Dorton Rb kcCo1ont' g: <br /> f <br /> Property Owner's Name: ((��� !J Pidoit <br /> Q,� � zProperty Owner's Mailing Address: B184 I�. 0aiti r '`(,I 'JJOQ 6,r MN%/ziQ o <br /> �l� City, ip a <br /> Property Site Address: ?S�a4 1 1 ,14 r., Ri, DI-(,,,r W( gof w. <br /> Contact's Telephone Number: (�J 1)?jO€j`G /? 0lc (61 aX <br /> o rn <br /> Contact's Email: 0 re-t r)Th � cnO4 G ep eel n. <br /> d <br /> Legal Description of Property: L+ 1 L,,SM V(, P 1 1 (&L 4 5) $1 17 <br /> Section#: a'i Town#:7-qt) N Range#: R f 0 o� <br /> g W Town of: i� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* °O <br /> d <br /> Tax ID#(1-5 digit number;found on tax �. • ent): 1 <br /> Proposed Use of Structur-/• •dit oa U!r! , 6 i 1 • r a eA1rmc) 1 date(o. v, <br /> Anticipated Start Date: l • (Home/Cabin;Commer ial Business;Bedroom;Deck;etc.) To o <br /> Building Contractor. DI <br /> i. - mono- Sewer Installer: A -7' =" d <br /> I «-3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY )\.1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to , <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z G <br /> home additions,and bunkhouses.** PcJ <br /> -- 11AtAs.1- - ,Now CIA P— 240-I.r r uireAn.eu -S, <br /> 12naAAA Ds Ps 7.5-:- /- s� <br /> rFq' 5-474e., peep,"1�/s ►^e-cl u, <br /> Fee Rec: l 5-0( <br /> 4 Check#: //415 <br /> rn <br /> Date of staff site visit: Kt'/Z/q l 4 Initials of site visit staff: <br /> ) 7"./ <br /> APPROVED BY LAND SERVICES OFFICIAL: 2DATE: 7//Z9 aft �CJJ <br /> -610 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1 I Gini <br /> 0 <br /> tea <br /> Transcendent: - Page 1 of 4 o <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 Q <br /> r"'7 <br /> b <br /> L 3) <br />