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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> Applicant Complete All Sections Below This Line E <br /> Permit Types and Fees:(Please,check appropriate boxes) I ° 9.3 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I 'h <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 F <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> xDriveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r- <br /> 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. -M <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 /> g <br /> Property Owner's Name: P4i1/1 f ilia.ry 6o rS'jL c <br /> Property Owner's Mailing Address: /370/ Pt)4/./ P i �p/� Valk At ft/xi ° <br /> Pie* <br /> � bvr State d Al ri <br /> Property Site Address: 13/0 3 7 ie* /Y X = Cs\___‘ <br /> / y' cA <br /> Contact's Telephone Number: 6 s�^Z4 0^4178 3111%.-- o <br /> /_ C. <br /> Contact's Email: p/Yl forS�/' 6///C/t� ilk . G4//'J p / _ ', L o <br /> Legal Description of Property: ��SO//f L GMOrt AV 04 J .1I 6 2i F 2Z <br /> 7� <br /> Biz i0 0 , <br /> x, <br /> Section#: /9 Town#: VOA/ N Range#: �4:. W Town of: ,f'��r� � <br /> *Attach additional page needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> if <br /> Tax ID#(1-5 digit number;found on tax statement): /9�j717/ ,m:. <br /> Proposed Use of Structure/Addition: /�'7 '--' 7/�1.Af... /'' n/ //S/sL T rn <br /> Anticipated Start Date: temp/ Z / T o <br /> {T' ��. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: La...4e. $ Dec /P4 0/_s• Sewer Installer: ///4- i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT'TO ALL CONDITIONS LISTED BELOW: 'J <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.** t• <br /> 0141e4- all Seg}- 5 <br /> E1 Fee Rec: Lc <br /> N Check#: _j <br /> LII 7/� ni <br /> ° <br /> Date of staff site visit: Initia of si visit staff: ' z <br /> // o BOJ <br /> APPROVED BY LAND SERVICES OFFICIAL: /�i DATE: i�t0`-1 < r- <br /> i� GI <br /> UPON APPROVAL: APPLICA M ST POST COPY OF > 0 W <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT OW <br /> ? <br /> Transcendent: - Page 1 of 4 , N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> rri 0 <br /> a Nil <br /> a LE <br />