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LAND USE PERMIT APPLICATION—Burnett County, WI c r <br /> N <br /> Applicant Complete All Sections Below This Line 0 <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) n'd C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r---' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 CD <br /> ( <br /> � <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �1 I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 g 9 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ON <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 -� <br /> *NOTE:After-the-fact permits(permit aquired 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. .2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: t� lit rJ Lt S �Gt 1 o <br /> Property Owner's Mailing Address: L1( 7_ `G �� 4�o S, TI 11� <br /> Q"1, se Mi( o <br /> 55135 , <br /> Citya. State Zip <br /> Property Site Address: c' <br /> Contact's Telephone Number: SSS, .2)&L ,t)6,-) 4' o <br /> a. <br /> Contact's Email: 2'f ^-Gh) 4\in(1 1.0 -- d <br /> Legal Description of Property: 2-04- 3 CA✓I'1V 12 1)46 `" <br /> 3 <br /> Section#: a Town#: //I N Range#: 1(QG 00 <br /> W Town of: J�✓I 55 ° <br /> E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): 199 <br /> rs <br /> Proposed Use of Structure/Addition: 0-a12 ri ,Ig `') <br /> Anticipated Start Date: <br /> p �L,� (Flame/Cabin;Commercial Business;Bedroom;Deck;etc.) I <br /> lVi d <br /> Building Contractor: Ge:-.,i-p- Sewer Installer: ti' p 6,1.'1S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 9•-) <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 _� <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home add' 'ons,and bunkhouses.** <br /> e1 ? 5e4b.1-`1"-5 �re c'''s <br /> w.e 6 t, iD ek €Ib <br /> Fee Rec:3(Z <br /> Check#: (*ID <br /> r <br /> Date of staff site visit:5 /�-5 /d. 1 J Initia o site visit staff: s)--' <br /> 7/ // ( 0 �L_�APPROVED BY LAND SERVICES OFFICIAL•� ,r/� DATE` 4 -- <br /> tri UPON APPROVAL: APPLICANT UST POST COPY OF 0 co, � <br /> a ° g C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o o <br /> Transcendent: - Page 1 of 4 14 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 m ff <br /> GO <br />