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LAND USE PERMIT APPLICATION - Burnett County, WI a c <br /> A..licant Com.lete All Sections Below This Line o c <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d 72,--()Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ' ., <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 TcO <br /> Accessory Structure(Commercial/Industrial), $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' ° , <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 0 Ili <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 2, D. <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 /> f <br /> r- 2 ii <br /> Property Owner's Name: CA-31`7(i) I l,7c(f)/ 0 £L 1 et-i z <br /> P <br /> Property Owner's Mailing Address: 17 W-70-3 / q 3 el(-2_et L oc' iit.6Gl rtg. Plr/ifrr(Z-Ha Q- <br /> City Statep ?O <br /> Property Site Address: 7Ce--1)il '5 er 1-)6-Lit L S L/,L (Z tV ( g5 ' <br /> Contact's Telephone Number: ' / .7-- 9#4-41 -- ‘ 9 9 4 . o <br /> 3 . <br /> C ', <br /> Contact's Email: 'j fi O (d £ (�- /4-___ A_______. 00 . 6'00-1 I <br /> o <br /> I <br /> n <br /> Legal Description of Property: j.� I7-7-4Ef/E� <br /> N ^c <br /> Section#: Town#: N Range#: W Town of: _ °` <br /> i*Attach additional page ifneeded for lengthy description OR attach a copy othe deed OR attach tax systempropertyPage.* <br /> P <br /> Tax ID#(1-5 digit number; found on tax statement): '3 O <br /> Proposed Use of Structure/Addition: X73 /rel cn <br /> Anticipated Start Date: ' `17//2__(...,2-/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: `r'( i9 Sewer Installer:ELl 577t to tiUl-liii-3L-77,-"-k---- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COM ME VTS/CONDITIONS ONNL /2 <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 them prior to `NI <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z / <br /> home additions, and bunkhouses.** ,, I , <br /> jpV <br /> NeeA .alit Chtt, � <br /> n an -t-c -}An k 6G 11 i;`I <br /> / <br /> g Aee,c-- 4 sOrbcicks <br /> Fee Rec:300 w <br /> Check#:3? <br /> J-1 Date of staff site visit: 3131 I�I Initials o site visitsa f: > <br /> o c <br /> APPROVED BY LAND SERVICES OFFICIAL: , / DATE: 6Va'3/P' < <br /> 3 <br /> �� <br /> UPON APPROVAL: APPLICANT ' ST POST COPY OF f <br /> N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> C <br /> Transcendent: - Page 1 of 4 x gj <br /> Laserfische: - Burnett County, WI Land Use Application— Rev 12/2020 a ' = <br /> a <br /> K <br />