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i <br /> LAND USE PERMIT APPLICATION - Burnett County, WI <br /> t - b <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Please,check appropriate boxes) J <br /> I Q <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> 00 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 S <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 (9 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 , ° <br /> '- d <br /> Filling/Grading $150 Boathouse $500 r• ``0' <br /> 16 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension Allowed Once) $100 a r <br /> n <br /> K 11 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. I d <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. (b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. --o <br /> Property Owner's Name: p(it AIV-e- QF- S o <br /> r,-7 1 <br /> Property Owner's Mailing Address: R d r a OA 2 Fo SfY-eoft t t.'�. 'S S if b 72 o N <br /> /� City State Zip <br /> Property Site Address: 3c?6 L)o �f �( �, <jl r Pt t,t.'d S C 1 72 i=• vn, <br /> Contact's Telephone Number: Z c <br /> , _ <br /> c. <br /> Contact's Email: D tI v-S C S�( 16,/17A t/f • C,flc>7L(Oil"- o <br /> d <br /> FD <br /> Legal Descriptionof Property: ,S Q C, )3 TN 3r �� 17 LC 1 I (Skr) V2,6 Pz4' ' -�gi,- N <br /> Section#: L e Town#: 3 0 N Range#: /7 W Town of: UJB!('t i.,C/5 °_ 1,4 <br /> _ °G <br /> *Attach additional page if needed for lengthy description OR attach a copy/oft the deed OR attach tar system property page.* p p-,.. <br /> 13 <br /> Tax ID#(1-5 digit number; found on tax statement): 2 -(Y CF(F' n' <br /> ve- <br /> Proposed Use of Structure/Addition: dorri <br /> Anticipated Start Date: c '� <br /> p MAI, 2 (� ( (H—ome/Cabin;Commercial Business;Bedroom;Deck;etc.) F <br /> Es <br /> Building Contractor: -� ptd S (0r ivrc c t0 Sewer Installer:,/0 ji"i�'2f' ' y <br /> { -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ob .,C• <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: P <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to t 14< <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions and bunkhouses.** z <br /> C5111 ch2 be c6ne +0 , ecf all Se+ S, ‘. <br /> a -Ex,5-iA &ve1(� , cb ae.. re✓nov g3 • <br /> arVtei 01,+ Lra,.\ f 1, <br /> Fee Rec: <br /> ''JJ IVidi <br /> Check#: a 6� t�Date of staff site visit: it"; s o t�ite visit •ff. � <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL:Irk r r DATE: qix3t.?-1 'a 2,- <br /> <''.7 <br /> uui <br /> UPON APPROVAL: APPLICA '% MUST POST COPY OF 3 o <br /> oe: (nt�i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT � a <br /> 14 Q <br /> Transcendent: - Page 1 of 4 m <br /> IND <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 • — <br /> E <br />