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LAND USE PERMIT APPLICATION-Burnett County,WI
<br /> Applicant Complete All Sections Below This Line 5 �..
<br /> Permit Types and Fees:(Please,died(appropriate boxes)
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200
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<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 j
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 =:
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
<br /> Driveways/&Campground Structures6$125 WI State Statute 59.692(1v)Structures $350 < ,
<br /> Filling/Grading $150 Boathouse $500 t=-
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<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100
<br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 'z ,
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees.
<br /> *Items not listed above wiN be treated as accessory structures,such as:pergolas,landscaping,etc
<br /> Property Owner's Name: I Lc'1 l c (,)(t.Lt :a L'i (ti) ((' n--,--
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<br /> Property Owner's Mailing Address: i a g A g I v S S C'S S-t: Al £ -2 b t'as /'Yl tt.l ,lis i 3.
<br /> �} City State Zip
<br /> Property Site Address: /7/n / //^e,n c's 7� /E'L) r[1 7,2,.moi rl,�...;' ,,,,� ,3-4430 c ,
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<br /> Contact's Telephone Number 7G 3 - ,. S ff- '/ 3 5 s� ® _ ,
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<br /> Contact's Email: )V(6 C:h en Gl Kr)/S 0 Z'd/Cx), CC,r'Y) o
<br /> Legal Description of Property: `J e 'i 1-1-z.c. c_ l-` 'Ea Cl. I c (2 C)
<br /> Section#: / ( Town#:1--10/0 N Range#: I (l; W Town of: (Qct K 3 /L,J 0_
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<br /> s*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q
<br /> Tax ID#(1-5 digit number,found on tax statement): / -4/ 7 Q 9
<br /> Proposed Use of Structure/Addition: S 1'1 C 0 I CG x I 15rsro
<br /> Anticipated Start Date: Prl '‘ ei 4,r', I
<br /> al (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o
<br /> Building Contractor pJ n 5 r'rI 1S i C (e C' S T 2Sewer InstallerC 1 k lit /l.G..:i .-tr C=c..t i' �t c c t�J_ ...i . �•,1 ••••-•••••••AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<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.** /�
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<br /> (dee+ ct,l( S -ai&s (5,8e 5eA ctck 1.5 i o c+)
<br /> s Fee Rec: / `-
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<br /> Check#: ,3068e
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<br /> Date of staff site visit:3/30/94 Initials ,f site visit staff: pi L r-
<br /> APPROVED BY LAND SERVICES OFFICIAL: q �/ / i / ,3 E/
<br /> DATE: 3, ' -) < ��J
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF A , gillSIGNED PERMIT APPLICATION IN PLAIN SIGHT N
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<br /> Laserfische: - Burnett County, —WI Land UseApplicationRev 12/2020 .,,�
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