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. LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> -o <br /> Applicant Complete All Sections Below This Line <br /> n t <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> U <br /> n <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 !i \ O <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 W <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 7-� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 o r- r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 rnrn <br /> *NOTE:After-the-factpermits h 1 t <br /> (permit squired 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: j �►r yi{' (4( <br /> / 4 I/? o ItS <br /> Property Owner's Mailing Address: 5� $ -70 / h ti(11 g4 <br /> City' State Zip <br /> Property Site Address: 6) y'tlll`ruV -f / � <br /> / P� ( <br /> � , � i / b cn <br /> Contact's Telephone Number: ---7i 5- 54 7-91,5-7 `eiC7 �Y• ,lL1 o n _E <br /> / L a <br /> Contact's Email: sl-yil lata ;/t'k' ,'? 0 rile cep lilt/ , fry-es <br /> Legal Description of Property: ( l" /t-, . / (" jt v 6 P/ZS , f r�ty ccry,, L <br /> x <br /> Section#: 626 Town#: e /7 N Range#: /7 W Town of: Okii/a i'I <br /> 5' <br /> m <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 7 <br /> Tax ID#(1-5 digit number; found on tax statement): (9. -6.)?(..) <br /> Proposed Use of Structure/Addition: R"V'711,--Y.' riec i '" <br /> Anticipated Start Date: k t � 0(2,?, .I ) (Home/Cabin;Commercial Business;Bedroom:Deck::etc.) <br /> M> <br /> Building Contractor: i,uSf I Afr--k i'�1FL. Sewer Installer: A//-,A{ 1 i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYN <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 O^ <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z00 <br /> home additions,and bunkhouses.** m <br /> — AO YO Ved 14/1941 VQVigNe - VAR —2/— D7. <br /> Fi Fee Rec:Ai/A <br /> y Check#: ----- <br /> Date of staff site visit: 3/�7/ Z/ Initials of site visit staff: J �r ' I Q <br /> rr — ZAPPROV ED BY LAND SERVICES OFFICIAL: �W>."----) DATE: 000Z/ nINUPON APPROVAL: APPLICANT MUST POST COPY OF 1 ^^0 <br /> Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Transcendent: - Page 1 of 4MI <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 <br /> K <br />