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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' <br /> 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) e, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure _$200 6 <br /> E. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 VA :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 "s',„, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 C1°e llJ <br /> Filling/Grading $150 Boathouse $500 - <br /> a pi <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t. k <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ^ i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: F-e,n1'1 G' Erick-6 c3.-ii z • <br /> 9 <br /> 1Property Owner's Mailing Address: 2t.01 C3 S Q/i C' 35 VA/N/5 -P/ V, / 5Gr✓ g <br /> /,, City 1n/ Sta e Z -o <br /> Property Site Address: �Z5J ipi'[ d (,jj �-ej/ V V Ps-, <br /> r <br /> Contact's Telephone Number: "311-g93-76-7/5. o i V <br /> �f_ <br /> Contact's Email: I Sa-rTQ�d tC 1;tu 0riu rtor,- tovvi S Il <br /> Legal Description of Property: 5w k f L. I - & A :lied o_ <br /> l in <br /> Section#: 1 5 Town#: 3€3N Range#: i W Town of: L(IhGOI it _ o. <br /> *Attach additional page( needed or lengthy description OR attach a copy * °0 <br /> p g f f g y of the deed OR attach tax system property page. C7 <br /> 7 <br /> Tax ID#(1-5 digit number; found on tax statement): (QLo 1-5 _' <br /> Proposed Use of Structure/Addition: q( f' L__ a�X 50 ' H <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck:etc.) <br /> llBuilding Contractor: 5e( Sewer Installer: Aa -i <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.** x <br /> 06rat#Ncere 140W'- h ,6e. use/ 61, Ammon 4Q4174 44 I. <br /> t, Till's Is qkx ctrger-A a-. CI- ,et.">17 <br /> 0 LL ,,,,ffes�,�-�^� / <br /> d er L e-�tiN / Fee Rec:.� <br /> hel y��� r� aH 7�/ � !U y <br /> to u t�,� ,•7// PA, I P; Check#:_155) <br /> Date of staff site visit: Initials of site visit staff: gj� z <br /> / � r <br /> izi <br /> APPROVED BY LAND SERVICES OFFICIAL:79 / <br /> DATE: ... Z( <F5 11) O <br /> RI <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a . n <br /> 0 <br /> 7, z. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 y Flu <br /> Transcendent: - Page 1 of 4 A m. 2 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> triorb� Eiiiii <br /> 0 <br /> 4 <br /> -o <br />