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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5 co 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> A Su <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 \ O <br /> I \ £ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 n° V <br /> Filling/Grading $150 Boathouse $500 a w <br /> Six Month Camping Unit(One Per Year) - $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CA <br /> *NOTE:After-the-fact permits(permit aquired 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. ,. .4i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - ,s <br /> rtr� o P' <br /> Property Owner's Name: CD'� V0/�( 7 (64( 449( V <br /> 2�Co <br /> V o <br /> Property Owner's Mailing Address: Pb (!! ci)k( 212 2 (t O� Dee12 �(e�(e CrC (-i , �a N <br /> City State Zip / .v . A <br /> Property Site Address: 21 �� Zete_ `moi!)C i Ctrs e 12,E 1 kJ i 8-14 , .(-) � <br /> Contact's Telephone Number: K:( 2 - D(o -i-'(3 3 o u <br /> 2 <br /> �r <br /> Contact's Email: V Olt L S 1 3 a S13, o <br /> Legal Description of Property: 14 16 1174-4e b LEt- l 'arTZS. LT7r 2— <br /> • t <br /> _ i <br /> Section#: Z( Town#: '3l N Range#: 1 W Town of: YaJ 4,16,c....- . 0'*Attach additional page needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> if <br /> Tax ID#(1-5 digit number;found on tax statement): �� LCI 1 <br /> Proposed Use of Structure/Addition: h., A.: cn <br /> Anticipated Start Date: g ./ / _Ai ,, 2 .�s (HA e/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> o b- <br /> Building Contractor:N(1'CM CO*iilt 1h0-4 Sewer Installer:10110a r-51(4/117111(-7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ' t F.....,... <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 <br /> home additions,and bunkhouses.** tx V <br /> -- No f- ex� 3 G o s per^ $ e f s`tee, ,, <br /> I� <br /> 2 Fee Rec: )- <br /> 1 Check#: 57g3 <br /> =. <br /> Date of staff site visit: 7i//31�Z(/ //�/�Z�Initials of site visit staff: /71- <br /> r ' <br /> :-. 1 <br /> APPROVED BY LAND SERVICES OFFICIAL:9 DATE:' 07247 ZC . <br /> 1151 <br /> •UPON APPROVAL: APPTICANT MUST POST COPY OF • $co <br /> �( <br /> cC = �' E1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0t <br /> • sv,� r•.) <br /> Transcendent: - Page 1 of 4 3 —' <br /> OE <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 w <br /> 71A <br /> 3 <br />