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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) . a. <br /> a' OQ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w �j <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `-� <br /> a._Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 $1" g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o • <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit aquired 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. - p <br /> • oo O. <br /> Property Owner's Name: --ie.,4 i'isk- A✓tom.II o <br /> Property Owner's Mailing Address:7 q 7 /),(afro /2,1, (-( S Ov i 6,i Z c y a /, °11o <br /> / �� / r City State Zi $ <br /> Property Site Address: d 7 S`'GJb/�G l 7, /CX, �NVf h62r� �✓Z ��t� cn <br /> Contact's Telephone Number: 6 57" `/ /) V 91� �' o <br /> ro <br /> Contact's Email: 3 CC ''t N L t(0 Si)G.h k p()IA)per-, U b ' d <br /> Legal Description of Property:Alt .Sit) c 3 ik --/-3 qi ,Z/94,/ <br /> (44,1/ <br /> N -0Section#:13 'Town#: N Range#: ,E(/ W Town of: Y7 Weir j' jji (4 J 0. 04 <br /> Cl' <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPaSe.* <br /> t. <br /> H <br /> Tax ID#(1-5 digit number;found on tax statement): p`g I ( 9- <br /> Proposed Use of Structure/Addition: Or/ ;— c A d S-- ' o iea awl g x/,f oa y <br /> Anticipated Start Date:Ch's i?-1-(y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: Pori-4/4.d 0vt,/ii jS Sewer Installer: <br /> / H <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 1...:.... <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** <br /> RI IVB- ( kv an k bikacht <br /> R 114.4dr All 5ekbc45 <br /> Fee Rec:� ,�, ��a/7 <br /> Check#: _y1` <br /> 4( rri <br /> Date of staff site visit: I 'tials o site visit sta z <br /> ci <br /> ., ! '� L/ 312- < , <br /> APPROVED BY LAND SERVICES OFFICIAL: ' / DATE: < L__J J <br /> UPON APPROVAL: APPLICA UST POST COPY OF a 110 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r <3 <br /> 0 <br /> Vii <br /> Transcendent: - Page 1 of 4 g m°e r..) r� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 2 az <br /> m <br /> m <br /> L , ) <br />