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LAND USE PERMIT APPLICATION—Burnett County, WI `° tr <br /> Applicant Complete All Sections Below This Line 5� !V <br /> co i Permit Types and Fees:(Please,check appropriate boxes) a. �' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure 2 d Q <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `Dt. <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 r <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r-...,.... y <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year 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. r <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. 0 <br /> Property Owner's Name: 'pyt. 4- e-1lL cS v U"...- z <br /> Mailing &PI0/ �k'&ip j eI/)o&s c5t Las Ve a.s, /JV o <br /> PropertyOwner's Address: rsj�l3c� o <br /> Citi State Zip .o <br /> Property Site Address: 407L 2 Met( rl/ - 1.Avtk' 1 Ort tburti [s4 $ W 30 5 <br /> a <br /> Contact's Telephone Number: (74 /qiR— v0,2o <br /> Contact's FEmail:_ f�n� d <br /> Legal Description of Property: Lo��i M�1�l� /y" ✓6' rp <br /> N ^o <br /> Section#: 3.5.-- Town#: (// N Range#: /6 W Town of: Swc'S5 5'g °0 <br /> °Q <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa8e.* <br /> 4 <br /> Tax ID#(1-5 digit number;found on tax statement): .3a7 30— <br /> 0 <br /> Proposed Use of Structure/Addition: rprc(-1 pec_1 - <br /> Anticipated Start Date: 51/31,9( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1t. y <br /> Building Contractor: —ite h rt c 4- . _- Sewer Installer: {,/.Pk�u�r Th.' d� <br /> -i c <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0" <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to V) <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** PzJ <br /> (0 N1 ee- all 564-{, <br /> Fee Rec:41OC) — <br /> c Check#: 359 <br /> /'3�/ I- <br /> 8 dDate of staff site visit:cal v(/b Initials of site visit staff: <br /> r <br /> / � __„,%,c_.-23 <br /> APPROED BY LAND SERVICES OFFICIAL: �' 41r. <br /> � DATE: WO < r <br /> ff <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a g� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o <br /> 8 IV <br /> Transcendent: - Page 1 of 4 A Li N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 g <br /> g <br />