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• LAND USE PERMIT APPLICATION - Burnett County, WI c'lc c <br /> Applicant Complete All Sections Below This Line 0' cn tsj• c <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `' ac <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,.j-t- (2 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> v Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> O) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° r. <br /> Filling/Grading $150Boathouse $500 C- —y <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aqui red 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: 6�y Oikj50A' z <br /> P <br /> Property Owner's Mailing Address:(..... 1 CIA) to/16 Lne. F /7 D °c <br /> / City • State Zip c..Property Site Address` SN-kr /)) A'/ti 6{1 jVok-&j 1 c' <br /> Contact's Telephone Number: 7i re)te/- is7 �` o•_ a <br /> 1 E <br /> Contact's Email: r C)/(7(r)-\\06 J rte'6 in (0 ( l�J� r d <br /> Legal Description of Property: rt—c_-S GOV- (a r 6 e V�(o„�� G <br /> Section#: 0 Town#: o Range#: /(./ W Town of: SC a/� L of °__ °G <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> 7 <br /> m. <br /> Tax ID#(1-5 digit number; found on tax statement):L /'7 7 ,7' ,-;� <br /> Proposed Use of Structure/Additio • IS E' SA7!V . let4/6 e� cn <br /> Anticipated Start Date: AsAt- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E x <br /> � o <br /> Building Contractor:A/MO CO 7)-5 r,40L'Ggc)v r Installer: <br /> AREA BELOW THIS LINE FO LAND SERVICES STAFF COMIIIENTS/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 front then prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** z <br /> 6Gana .s mol" exceed et �7/ of 70 5Q'G4rl. Ceti; <br /> ; <br /> Q v 1 5 , r i^s y,, IDG rew4 01/'C.6' oh Gt A e.44 o e S 4 • .__, <br /> Ce bt/1/ / L = Fee Rec: /VSa` <br /> CI /v� /0ch- 4'ncieAA►/sA toil s 74t I 4S i/ 7/1/�Z'( Check#: Et,CA <br /> Date of staff site visit: �/ y/ ��� Initials of site visit staff: /t rn <br /> W ! <br /> /// 666 � �__._ ,• <br /> APPROVED BY LAND SERVICES OFFICIAL:79.4...-- ---7DATE: "/ �6/��/ <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF <br /> i• i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTw1=1 <br /> Page 1 of 4 ii.." <br /> rj <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 u � <br /> J <br /> D <br /> 3 <br />