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LAND USE PERMIT APPLICATION- Burnett County, WI r <br /> a 2 <br /> b <br /> Applicant Complete All Sections Below This Line _.g' c <br /> Permit Types and Fees:(Please,check appropriate boxes) ,c- o_ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I (�.f,�` <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ` � <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° r <br /> Filling/Grading $150 Boathouse $500 , C- <br /> XSix Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 - &-) �� <br /> ) r <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. - <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. '' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> r 9 <br /> Property Owner's Name: a / I ,y� ° z <br /> ilk <br /> - o <br /> Property Owner's Mailing Address: SS I Ig I y3f, , 7 r (f . J(,Qc� o r! <br /> City State Zip 3 <br /> Property Site Address: .�O..:. g O I Q ��z , "lint,(JJ, t (/. _ c' <br /> ty � <br /> Contact's Telephone Number: /- 5-0/7 - `07O ._ 1 g g <br /> la a <br /> Contact's Email: _ o <br /> w <br /> Legal Description of Property:c 7 O 3 -c-1/- /S-„2 - 5 0 S p <br /> Section#: ›J b/4-d�, c <br /> ,�� Town#: L�/ N Range#: f$ W Town of: ac <br /> - <br /> *:9ttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> J <br /> Tax ID#(1-5 digit number; found on tax statement): a / 5 9ii <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck'etc.) c x <br /> Building Contractor: Sewer Installer: 56 c <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to V) ....=_AANY construction taking place for any dwellings, dwelling additions,manufa tured homes, manufactured z <br /> home additions,and bunkhouses.** x <br /> p Osie Cwnret ?et li* Fermult <br /> 0 peri; ;res Nov. ?� , <br /> No P cr fr�5 ,12:, I - I f roveg vnfi l Q 1�l kt- <br /> ►S 06+4%;Yl dim`- 21 (50.444 of 30 AO G110.A4� c4�.n ivr3' Fee Rec: /�— <br /> �! s Check#:Ub 5 <br /> Date of staff site visit:5//7/7- I Initials of s• e visit staff: , /l7/2•l '2lL z <br /> z.,-, <br /> APPROVED BY LAND SERVICES OFFICIAL:�� �& .j // ' 1V DATE. Lib,/b,/ :-Ff, <br /> ���'{ <br /> UPON APPROVAL: APPLICANT/►' ST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 .Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 < <br /> o <br /> 3 <br />