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LAND USE PERMIT APPLICATION— Burnett County, WI g <br /> i <br /> Applicant Complete All Sections Below This Line ' <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> .'" - 0 <br /> 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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �k i <br /> ccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $1507V , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> $' 6) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 C '' <br /> Filling/Grading $150 Boathouse $500 t- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. P <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. g Z <br /> P. <br /> Property Owner's Name: /�1 i )/)t/ ' 5 /1 - z <br /> 5S3JC ,i IIID <br /> Property Owner's Mailing Address: l yy/y 5 IJQ,Zf LR/1.t .- 4, /n///QL-&ileff Ai/ g 6, <br /> City State Zip <br /> Property Site Address: 260,-9 SKr/ )Af /if i,ve_b k7-, h�lL 5 '8-'3? ? F. <br /> kp <br /> Contact's Telephone Number: Cf 5---a/ - -/� ,..2 . 1.-- o e <br /> Contact's Email: Cakj) iAg i 1 )',--kg 1.--"I L D/1..e/,7/ e 4*-, --t b <br /> Legal Description of Property: H ,, c J -t- 6 i-e4' act4, V V 1.-0 t- /V <br /> t N b <br /> Section#: .2„g Town#: y0 N Range#: /b W Town of: 7/9C/ 5,e/115 °° <br /> t . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa page.* <br /> d <br /> y <br /> Tax ID#(1-5 digit number;found on tax statement): S.3ag 5. <br /> Proposed Use of Structure/Addition:y/I/f h''p c A ea/ Q L C- I-o fey 7'--/Z6/10--"- `" <br /> _ G o <br /> Anticipated Start Date: 6/i�//2 I (Home/Cabin;Commercial Business;Bedroom;DDeeckk;etc.) <br /> Building Contractor: Sewer Installer: /(//// <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY '- k ,., c,\; <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 W <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured Z O <br /> home additions, andnkho ses.** %e D <br /> /Iiee - �6 <br /> CA cck'5 <br /> a' <br /> g Fee Rec: z5 <br /> va),IL <br /> ���( g Check#: i 0 q') <br /> Date of staff site visit:5 ' I I 'ti. . of 1 e visit s f: <br /> F- f <br /> APPROVED BY LAND SERVICES OFFICIAL: �� /��DATE:5/) / <H- <br /> UPON <br /> "/S T COPY OF APPROVAL: APPLICANT S POST � �� � 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r m m J <br /> ' O <br /> o <br /> Transcendent: Page 1 of 4 �� N <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 <br /> • (lir <br /> i (,.... )J <br />