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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) e, <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '\ �O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> nt ,..._... <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <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. aC dk <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: /e.,//ti) i �✓1 GL.,s-Q`Yl. � �N\ <br /> Property Owner's Mailing Address:��p ,95.-- l � �/Ei "�v. i .."65 o <br /> l ' S i City Stag Zip <br /> Property Site Address: 91-.,,,/ 4/GP f�s'1 �,�bralU�bs f LeL SY�9 n <br /> CA Contact's Telephone Number: 715-- ..?-7-7S"Sej o N <br /> • c <br /> n. <br /> Contact's Email: ko(15 orc;fit'dk.cL.u, O tia,kcir,. ()owl \ d <br /> Legal Description of Property: SW 5E eX S woo' OF E C.v(.On. <br /> N ti <br /> Section#: 15 Town#: -39 N Range#: i7 W Town of: (-ih(,p I{/l C° <br /> tiq <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly property page.* <br /> P. <br /> 7 <br /> Tax ID#(1-5 digit number;found on tax statement): 1(��DS(P 5' <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 1.1-" I- a_/ (Home/Cabin:C mmercial Business:Bedroom:Deck: tc.) <br /> � <br /> Building Contractor: K..Q, . Fr jin Sewer Installer: r/ h h v t4 .9 o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v <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 thew prior to <br /> ANI''construction taking place for any dwellings,dwelling additions,manufactured hones,manufactured z <br /> ome additions,and bunkhouses.''°* <br /> l /Vof e� 2- 6 e-hookas hoS en ,Sei/4/4v <br /> ex._-•cpeop.a4i u�red USG ��.rw„ s> Jin /�i #so4 <br /> Fee Rec: <br /> uCheck#: `�� <br /> 0 <br /> m <br /> Date of staff site visit: q• fg Z/ y,70--/2. , n <br /> 3 / Initials of site visit staff: z <br /> I - m <br /> APPROVED BY LAND SERVICES OFFICIAL: fa" i •TE: Z V < r- <br /> 3 <br /> gal <br /> UPON APPROVAL: APP ' ICANT MUST POST COPY OF F Tm <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °2 a = Guy, <br /> m? <br /> Transcendent: - Page 1 of 4 14 P <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 <br /> mm ,51 <br /> a a <br /> ro <br />