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LAND USE PERMIT APPLICATION - Burnett County, WI g <br /> N <br /> Applicant Complete All Sections Below This Line 8. a <br /> Per it Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> 10,1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `(-)N <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ll _ ( <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ,- ~ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° brid <br /> Filling/Grading $150 Boathouse $500 0 <br /> II <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 2. <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. CD <br /> �r;1/2(7e._ dhe-h-5 Property Owner's Name: `_ishi.d{ 1 4- r;1/2(7e._►! o z <br /> Property Owner's Mailing Address: 797. ) 6 ^Ce..A.Aehie/P ki‹,Jl C2) i-i ‹._ 6 ped de E i <br /> PAL./ <br /> City State Zip $ <br /> Property Site Address: n L./�1J )'2)e /�fn/ 5.5X16 9Liis')— ?J4 - 69i, <br /> Contact's Telephone Number: o c ; <br /> CD <br /> Contact's Email: ,. /'Pell 4-Ri�''j . C �J r 6a/itC7 <br /> Legal Description of Property: e7 ma d - ///-/4 -3.3"-a e)l eJocldtib <br /> �9 0 c <br /> Section#: j5' Town#: .11/C N Range#: lie W Town of: j�/SS o o <br /> 5' <br /> cm <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 D L 7 �. <br /> Proposed Use of Structure/Ad i 'on: `4 <br /> Anticipated Start Date: 3/)/01 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> z 0— <br /> Building Contractor: Sewer Installer: <br /> /ICA X1, -3_ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E C P1 <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, an unkhouses.** 5�-�accieeeb �' <br /> 111 ee-c- At, � ,e,G,00✓i'2 S <br /> z Fee Rec: 3CDSC2 <br /> P.v <br /> Check#: �D <br /> Date of staff site visit:5)111)- <br /> Initials i f site visit s •ff: . / <br /> A i • 1 • //pi <br /> APPROVED BY LAND SERVICES OFFICIAL: i, I <br /> DATE: ? I a' ED UPON APPROVAL: APPLICANT i ST POST COPY OF SIGNED PERMIT APPLICATION IN PLAIN SIGHT VP rN, <br /> Transcendent: Page 1 of 4 Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br />