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LAND USE PERMIT APPLICATION - Burnett County, WI a C <br /> cn IN) <br /> Applicant Complete All Sections Below This Line '' <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 4- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 , 0 <br /> Accessory Structure(Garage,Shed,etc.) $150_ Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ; F. p <br /> Filling/Grading $150 Boathouse $500 C- <br /> 0 NI <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 l <br /> cn l ' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. d <br /> E. <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. n <br /> Property Owner's Name: d., 7,...,/C5 .�t.�-ker-- T o <br /> Mailing f'�V YJ • <br /> `H/" il <br /> 6.1 <br /> PropertyOwner's Address: .7 �`� CW�v17( �(G /7/� -5-9.al�� <br /> A <br /> WState ,Zip - t <br /> Property Site Address: 3b5x, beef- L-cri c, IV -' f(4Jct am b(,._yy lilt t .• <br /> Contact's Telephone Number: .S 01 `q51- 64-10 Z o F <br /> Contact's Email: 16. E 3011' 0 ch 5 t'1 a 0 > o <br /> Po <br /> Legal Description of Property: Ake-a_L Jq CI' <br /> Section#: 13 Town#:7`0/ N Range#: 4.3-- W Town of: ja_�sW 5c, o a� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> O <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: / e/72 . `..j &City 'K.) w' <br /> �� o <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) £ - <br /> Building Contractor: `�' Sewer Installer: XII' r---- o <br /> --i ,..s..." 1,5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMIMIENTS/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.** z <br /> I Meed adl5 <br /> D, �jo}- }o ext a becrco'15 Jo 4'te 1 .5 e <br /> Ne .e LatiiikCyl1;1 of 0 C. <br /> Fee Rec:c,1OO <br /> 62) <br /> Check#:55E9 <br /> ) �-UDate of staff site visit: t11 `Q /t)-4 Initials of site visit s .1:1-1 L Z <br /> � Al �J it/ <br /> v <br /> APPROVED BY LAND SERVICES OFFICIAL. "!• ' . DATE: -1t <br /> UPON APPROVAL: APPLICANT f/' ST POST COP OF m <br /> co W1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> a <br /> Transcendent: - Page 1 of 4 n w c �I <br /> Laserfische: <br /> Burnett County, WI Land Use Application-Rev 12/2020 5 <br /> m al3 <br /> 1 <br />