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LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 8–. <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> , 4 <br /> Dwelling/Principal Structure I$300 ' Addition/Alteration to Dwelling/Principal Structure I$200 5 <br /> n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 — <br /> ..- - <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,'�0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° op <br /> $150 Boathouse $500 r w <br /> o <br /> Six Month Camping Unit(One Per Year) $100 t Permit Extension(1 Year Extension-Allowed Once) $100 III <br /> o' <br /> f. <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. , `y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ro <br /> n g' 1 p <br /> Property Owner's Name: &A Ud,Lfr1GfW Z <br /> P P <br /> Property Owner's Mailing Address:���� {���d-1n .Se. �14X44e {n1 V ST a1 o <br /> /�d �I bvT" City State Zip I ' r <br /> PropertySite Address: r„ • <br /> Contact's Telephone Number: Ca—7/0-7/477 c <br /> CD <br /> M. <br /> 5 <br /> Contact's Email: frr 0 jc3 Wi'r't- ,CO,"' d <br /> Legal Description of Property: 1041- CS()O <br /> Ula' Pili-04 4,v � (t7 <br /> r.0 <br /> Section#: '14 Town#: Li a N Range#: ki W Town of: .S� o <br /> r o <br /> 7' <br /> ac, <br /> *Attach additional page if needed for lengthy description OR attach <br /> �acopy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): I b o 7n.S <br /> Proposed Use of Structure/ ddition: Cwt h `" <br /> Anticipated Start Date: Ili 24 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v 73 <br /> x <br /> Building Contractor: 1304 13-//h,Itne.+'ty Sewer Installer: h.1� v d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y <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.** <br /> 0 UI kee o� 5%14"Cefice +o (1&,,k 5 ;I� cerk,e, cc, I 6.4t'<_. <br /> oao Per ,k LuP-Q -/S9 <br /> x � 4 Fee Rec: b — <br /> l Check#: i r33 <br /> 3/31 /�I u <br /> L o <br /> Date of staff site visit: initials of le visit staff: <br /> z <br /> IV <br /> I rn <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL:%y , ��DATE:�1/I/�l 7' n �QJ <br /> UPON APPROVAL: APPLICANT BUST POST COPY OF a a GW <br /> 70 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 m 3 E����l <br /> Transcendent: Page 1 of 4 m 8 N <br /> Burnett County, WI Land Use Application—Rev 12/2020 n ' 4 Q <br /> Laserfische: - pp 7 :� <br /> o m <br /> 1511U <br /> L -J <br />