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LAND USE PERMIT APPLICATION - Burnett County, WI a c <br /> b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) a 10 <br /> Dwelling/Principal Structure ,, <br /> $300 Addition/Alteration to Dwelling/Principal Structure $200 � <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 lk ..(O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk\i( <br /> Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 g) ii. .... g <br /> ° P <br /> .,, <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 '— <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1 <br /> 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. I �? <br /> r- r <br /> yam,/ <br /> Property Owner's Name: /�i a,y 1� �(�t,b RA.m.Z o f <br /> Property Owner's Mailing Address: 1 1 3 5.-- / .---: !� S V i C 1"-I �{�r5V-t Ali�0 1534 7 o <br /> ,JCity State Zip -0 j <br /> Property Site Address: 3 0 t� (e I Q jjt/e/t' CJ Gc c n (15 <br /> Contact's Telephone Number: '7(e 3 -2-`1 I - 54.2-9 c <br /> Contact's Email: r frk s 5c.14,..,114pnP,- /9 5 7 ' ,f,a..)1, D P„ <br /> _�L <br /> Legal Description of Property: 5(a e 0_5545s--v-5 0`7" LL.-0 -/ /q <br /> N <br /> Section#: /3 Town#: 411 N Range#: i W Town of: (5'6(4.'5 _ cm <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> s' <br /> Tax ID#(1-5 digit number; found on tax statement): 3 Z_ e0 <br /> Pee:--'Proposed Use of Structure/Additio : l�ek._ "' <br /> Anticipated Start Date: il—pr t ( 3 0 (Home/Cabin;Commercial Business;Bedroom;;Deck;etc.) £ x <br /> Building Contractor: / Se / r Sewer Installer: I c Es <br /> kb <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 L1)16 <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** Po 0 <br /> 62, Mee, 41( <br /> Fee Rec:l,.52 <br /> Check#:.2,467 <br /> 1 r- <br /> Date of staff site visit: `I I 71 I Initials of ite vis' staff: z <br /> APPROVED BY LAND SERVICES OFFICIAL: - DATE: libeP1 < <br /> Effil <br /> NT--"M <br /> UPON APPROVAL: APPLICAUST POST COPY OF <ma A <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z Nil <br /> r 0c a <br /> Transcendent: - Page 1 of 4 . a <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <B <br /> �� <br /> 3 <br />