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LAND USE PERMIT APPLICATION— Burnett County, WI ~o <br /> a B <br /> Applicant Complete All Sections Below This Line o <br /> n. <br /> „1. <br /> Permit Types and Fees:(Please,check appropriate boxes) V 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d Jc <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $2002. 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 0Fio <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk unkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 n <br /> Filling/Grading $150 Boathouse $500 r- <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 1 <br /> *NOTE:After-the-fact permits(permit squired 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. '' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ',7 V\ <br /> ` t r P' M <br /> Property Owner's Name: S i\\ 1- SS•c-`,, o �k <br /> {� ' nn o <br /> L.‘ <br /> Property Owner's Mailing Address: 53L Z, JraA 14, t.D r {-lu,c,bi n,n tJ �(/d 1 ' 'i <br /> � City State Zip $ <br /> Property Site Address: 3 R(00 S()t c.Atn 5 � 1` <br /> , � Er <br /> p 6S 1— ,Q7y — `-�7U �:_ , _ <br /> Contact's Telephone Number: _, o <br /> l, 0. <br /> Contact's Email: 1 Q 5e .; r �} Q f\o me&t' ► C dMn C7 <br /> Legal Description of Property: <br /> N -o <br /> Section#: Town#: N Range#: W Town of: u.G.KSO 0 0 m <br /> B. <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> �` <br /> P S f f S Y P Y P P ryP b q <br /> Tax ID#(1-5 digit number; found on tax statement): T' <br /> ^ <br /> Proposed Use of Structure/Addition: 0(�(A € o'Y e r - 6/V/N- CA <br /> w <br /> Anticipated Start Date: �j /7,0 1 ZQLD (HomeyCa in;Commercial Business;Bedroom;Deck;etc. o x <br /> Building Contractor: {.{ w <br /> , KCnI 1 4S <br /> Cid I GtBrs Sewer Installer: -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> il <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their LDC Inspectorvctordetermine i permit is leder i th lior to <br /> ANY construction taking place fo*an wellk_nt /`/� ' a di�nn �i� d hom((smanufaetut�ed z <br /> home additions, and bunkhouses. .No e I !'l i ��� car• Logs s+ <br /> J r {�© �- uta Fl-t) AccQiauti+- <br /> � 5 <br /> O ARI p J b►rl9 \n xco ceru.cres a b\1 o�-t 1, aoata. <br /> ( m) cr `"'e corv\ec+— ec(�N • _ <br /> klk‘i <br /> r -fin / P _• <br /> / 'I <br /> ® Re -t'r'�2 / ` o 041. <br /> i&coA cj horC.l t ?e ne�(a�‘•}—/� �`1'��a Fee Rec: ole U Check#'��.L/.Z <br /> i' /,,''' J�A� 4c �co-,t t <br /> Date of staff site visit: /� i Initials of site visit staff: V" Z t" 1 Lq $l <br /> G. 5.e e. ge -Focet1 tO►1 ( tl�o ti-2 •eq C <br /> APPROVED BY LAND SERVICES OFFICIAL: '�, �: 4.....a........._DATE'• < t <br /> r��' CODz t <br /> m <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF = R '' <br /> > . 0 <br /> T <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> - 0 <br /> Transcendent: Page 1 of 4 n zK I <br /> Laserfische: Burnett County, WI Land Use Application —Rev 6/2020 < 3 e <br /> T C <br /> CA <br /> Z I <br />