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LAND USE PERMIT APPLICATION - Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line = c <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,� <br /> y) Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 .l <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 5?. <br /> t <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(lYear Extension-Allowed Once) $100 <br /> v) • <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g <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. 1' <br /> Property Owner's Name: ` k ' a ' A- OW I � ..2i. r LI/ a__..so <br /> Property Owner's Mailing Address: 0.A gR7 (r V{ L0 lea 0 ke�hti u s-4837 g , <br /> P City State Zip <br /> Property Site Address: =' <br /> Contact's Telephone Number: - 5? -2-1Q — ( „4,/ \ o <br /> Contact's Email: ' o k a • _ . 1 - r 1 ' ` ._ , t.05 h • . , --,,,e ' <br /> v <br /> ro <br /> Legal Description of Property: 6,4 2 c. GIS <br /> �� N ^U <br /> Section#: I( Town#: 3-1 N Range#: (1 W Town of:1 YV.&..Q L .tL. 0 0 <br /> E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> q. <br /> Tax ID#(1-5 digit number;found on tax statement): 234'(3 <br /> Proposed Use of Structure/Addition: P v (o-L I`V\* g <br /> Anticipated Start Date: P40.r'L(r\ 20 LI (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) s <br /> L. <br /> Building Contractor: L rn.lV&.(,61U 4d //OJt�/ Sewer Installer: �( X d� <br /> / H to <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N <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 /> h me additions, and bunkhouses.** <br /> / No Sail i r /OA caoGOes <br /> S sal, no �H�oor'P/ <br /> yY R) <br /> Fee Rec:15a el" <br /> q o <br /> Check#: a ooD <br /> ni <br /> Date of staff site visit: 3 / �Z Initials of site visit staff: )� /// �/ z <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: `� -DATE: �� ZO?// ..� <br /> n m Nil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFW <br /> X .3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 2 o ..A <br /> Transcendent: - Page 1 of 4 �� c4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 m g 1] <br /> K <br />