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LAND USE PERMIT APPLICATION- Burnett County, WI a" <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p 0 <br /> c) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 V <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r r1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o N, <br /> K <br /> *NOTE:After-the-fact permits(permit squired 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. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> '7 ^^,�� g <br /> Property Owner's Name: Llnl,5 C A 0( Oityt c� . <br /> ., <br /> Property Owner's Mailing Address: .39 5G / U ergo, .5�,N=l1 Sie,xe4vief1/,0 530 jCj o <br /> (3q/ W�'e i.5 eh (Z D City State Zip <br /> Property Site Address: 4c4(- <br /> Contact's <br /> Contact's Telephone Number: 442-6S_5-. 7 o ti <br /> of <br /> Contact's Email: C)t.ri Koc,/tn .Ge e G iv?c r/ - (Oh'? d <br /> Legal Description of Property: Ste / eV- 01 3.j Ry /7 t 'jam W NE S G <br /> .-0Section#: I'1 Town#: 361 N Range#: /7 W Town of: I-./h C 0 l in °N. b0 <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): 3 L' f C' 2 <br /> 5. <br /> Proposed Use of Structure/Addition: 5lOr 7✓ <br /> "'Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> d <br /> Building Contractor: OU/A Sewer Installer: /(�/�/� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 7 S <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 /> 1,,,,,,,,,,,,,8 <br /> cainvej, 4,7 <br /> .�t,t l l Co nom,n,( oec a II wa <br /> x Fee Re:/5 -- <br /> .c.: <br /> - <br /> `o <br /> Check#: J53v <br /> qM <br /> Date of staff site visit: LV I I 1 1 a , Initials f site visit staff. )4z <br /> / dr"-- <br /> . <br /> SAPPROVED BY LAND SERVICES OFFICIAL: / /� DATE: /��( �' <Fl 0 <br /> giii <br /> UPON APPROVAL: APPLICAN UST POST COPY OF y -43 yV VSIGNED PERMIT APPLICATION IN PLAIN SIGHT zr�iuTranscendent: - Page 1 of 4 Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 < <br /> o <br />