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LAND USE PERMIT APPLICATION — Burnett County, WI t—, <br /> Applicant Complete All Sections Below This Line 5' c <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :t w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> ,\ Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> M <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r( V <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 L k <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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. to <br /> g <br /> Property Owner's Name: RC) b e.-/`1— '� -e- o �� <br /> Property Owner's Mailing Address: 10 (p 1 Pe r K `` am ktYy io't' 5�v30 o <br /> City State Zip -o <br /> Property Site Address: 50tilln- . ri <br /> rn <br /> Contact's Telephone Number: ,1 )..- 75 O — D <br /> 6 . o <br /> Contact's Email: rte T012 i 9 /IV CD N'1 kir, ter(' o <br /> CD <br /> Legal Description of Property: 0t.5 ft ._ ! ., QIn L/f IC , 3ec it,/1,4 tifk,Lit 4V," <br /> e o <br /> Section#: 19' Town#: 40 N Range#: `e W Town of: 0 aI</4 v4 of o <br /> E. <br /> *Attach additional page if needed for lengthy description OR attacha copy of the deed OR attach tax system property page.* o,:p <br /> Tax ID#(1-5 digit number; found on tax statement): 1 q G(0 .1' <br /> Proposed Use of Structure/Addition: C it<LSA`.. o r e_A v) <br /> Anticipated Start Date: 4o a <br /> p /" ��' Z V Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) X <br /> Building Contractor: S e 1 4 Sewer Installer: <br /> -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY w=3.- <br /> THIS <br /> =3' <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 _ 0 <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured Z <br /> home additions�nd bunkhouses.*�4 cteiltS <br /> Ai - 6( 11µmm lub, b7) <br /> = Fee Rec: / -- <br /> r Check#: Olga <br /> Date of staff site visit: li/?7l a I Initials of .'te visit taff: <br /> i- 'DATE: <br /> / 0 <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL. 'I' 1 /2 �.., i =I/UPON APPROVAL: APPLICAN OSTCOPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 5 <br /> Do C ..�. <br /> c <br /> Transcendent: - Page 1 of 4 T w r <br /> Burnett County, WI Land Use Application —Rev 12/2020 - g• - <br /> Laserfische: pP _ co <br /> ff <br /> ?. <br />