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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> oP <br /> ET_ A..licant Com.lete All Sections Below This Line 0' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> pe-- Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ).) <br /> i___Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \, i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> - <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C <br /> Driveways/ Campground � <br /> Y pg $125 WIState Statute 59.692(1v)Structures $350 � & , <br /> Filling/Grading $150 Boathouse $500 r � <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 IC <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. <br /> w `-- <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. o <br /> 1 <br /> Property Owner's Name: (� f t - r �S1-'51 ° <br /> Property Owner's Mailing Address: 31 7tiZ /�/ /4P R JJp p9j(l�l turx.svQga o <br /> P <br /> City State Zip ti <br /> Property Site Address: 3 17?/' PIi-vt?y LI't1 (t) Effie) 6(�`y US36 E E0 ft A <br /> Contact's Telephone Number: 7 1 J - 2q r 9L( I1 .J r, <br /> Contact's Email: k%L CMI tfVi ®Cr-72/9/t, . cutli <br /> 0 <br /> Legal Description of Property: <br /> Section#: / Town#: (-ii N Range#: /6 W Town of: ....50..) 1 S 5 - <br /> aM <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CrU <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> 4-6 irte c 4-ccr 5Yruck.r ' , <br /> Anticipated Start Date: (Home/Cabin;Commercial Business,'Bedroom;Deck;etc.) <br /> J— • <br /> x£ <br /> Building Contractor: 1-169-t, OVIA Sewer Installer:Qt, ts �J /tits'-N' <br /> AREA ° <br /> BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r. <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> (11 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** x <br /> IM <br /> ee - aLl Se-1 .cki. <br /> I <br /> p,,vei1;� (4- el° esc 3 bee rao'hS per 54 - i-e7 <br /> 2 Fee Rec: 450 <br /> U Check#: j-15 id <br /> Date of staff site visit: ///q'4 Ini '.1st <br /> 1s f site visit - aff: ).-1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:6//l//2"'/ su <br /> UPON APPROVAL: APPLICA-'/'QST POST COPY OF c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g N . <br /> Transcendent: - Page 1 of 4 x 3. <br /> Burnett County, WI Land Use Application—Rev 12/2020 - _ � <br /> Laserfische: PP <br /> .7 <br /> 3 <br /> z <br />