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LAND USE PERMIT APPLICATION — Burnett County, WI a [ <br /> . 7,' 5 N <br /> Applicant Complete All Sections Below This Line ° �' <br /> Permit Types and Fees:(Please,check appropriate boxes) G <br /> d �— <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 /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 X— <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 6 `R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 , ° <br /> IP <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 1 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 3 <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. 1 r 7 ; <br /> ( <br /> Property Owner's Name: it-1 ► (�`1-C! $, ` r` '� c�t � z '' <br /> Property Owner's Mailing Address:-141i- et y g y1 �cI N N � �l ✓� �� G P� WI' 0 0 <br /> /� City ,',, tate Zip �_ In <br /> Property Site Address? Pi Sn q /4/1. Ca N #i - y1 4✓"e Dllo <br /> oN� _ W/ $' ?3d °' <br /> Contact's Telephone Number: ? )5- •- sb " 0 q' S <br /> o. <br /> Contact's Email: 117-rtT O ref it 0 Q 2 5 / CO d <br /> Legal Description of Property: 1,o f L. C S)1A t/6 P 5 A x 5 S-0 / <br /> ik b✓ 0 6 S~ / <br /> N � <br /> fig <br /> Section#:1 c( Town#: 40 N Range#: 16 W Town of: e. t (q k e <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa page.* tic <br /> O. <br /> Tax ID#(1-5 digit number; found on tax statement): i q b I 0 L <br /> Proposed Use of Structure/Addition: Sie e a 1 -t v' <br /> Anticipated Start Date: It — 2. 3 — -z.O 'L (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) . £ x <br /> E, <br /> Building Contractor: Sewer Installer: <br /> --1 <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 then:prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** %' <br /> I \j \- �t ,(4� ,6c0;-6,..i,'0h <br /> ,e„, <br /> all 54-bactites <br /> Fee Rec: <br /> Check#: ao. <br /> Date of staff site visit:LI figi0,71(� C <br /> Initials i site visit staf : >. <br /> / • ' __ <br /> 1� <br /> APPROVED BY LAND SERVICES OFFICIAL: " 7,P DATE: Yl O`d4 r <br /> gThl <br /> UPON APPROVAL: APPLICANT' UST POST COPY OFc <br /> 70 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT b <br /> G'7 <br /> Transcendent: Page 1 of 4 . A..� ro <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 . 't-. <br />