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LAND USE PERMIT APPLICATION—Burnett County, WI c t~ <br /> Applicant Complete All Sections Below This Line c' . I—, <br /> Permit Types and Fees:(Please,check appropriate boxes) a 1-..... <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 .� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 C. fJ <br /> in Unit One Per Year) ° <br /> Six Month Camping g ( $100 Permit Extension(1Year 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. I �1 b <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 ro <br /> Property Owner's Name: 6 d 0& Z4 rrt_., <br /> Property Owner's Mailing Address: 6 y<6 574 gat 7 © S. ."en (,i . 5jv,c.3 — o , <br /> a. I, <br /> City State Zip <br /> / Y6 Property Site Address: � Sr IN =. r)/ E <br /> Contact's Telephone Number: tv /a g.C)c -7 G1 4'5 <br /> Contact's Email: L4 er< tie fii S 4 Co#41 L .' <br /> C7 <br /> Legal Descri tion of Property: <br /> ` o <br /> N '0Section#:k ,5 Town#:.39 N Range#: ` t W Town of: yln C<M D•1 <br /> B. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): a Lib p a <br /> Proposed Use of Structure/Addition: d 3 io r� S)' I cu/,b;�,0( rn‘ cil <br /> Anticipated Start Date: A.5() (Home/C�;Commercial Business;Bedroom;Deck;etc.) 44 o <br /> 0— <br /> Building Contractor: J Pill 6.5 C Pi L LC, Sewer Installer: Apt/1%V._ <br /> 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.** Po $� <br /> O ,W- be- loci -fir tiuiA4gA 11Q6/767+o4/ <br /> ® GaiticL £1t fe.+ M!'/ " 1 ee 06T41,t a 'fn✓� Ay Sie <br /> 61 6///Ze zih Fee Rec: I5/7� <br /> y <br /> Check#: I l�'� <br /> M <br /> 32l Z0C / <br /> Date of staff site visit: Initials of site visit staff: ii r z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: ii//04eZ/ 'i <br /> D <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 4 a GW <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 g <br /> '< 6 cD N (� <br /> Transcendent: - Page 1 of 4 M w n w tfo+� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 g cn-.a <br /> i ! uuu <br />