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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> g <br /> Applicant Complete All Sections Below This Line o- G <br /> Permit Types and Fees:(Please,check appropriate boxes) a ' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 °» <br /> Commercial/Industrial Structure $300 7- Addition/Alteration to Commercial/Industrial Structure $200 "3. <br /> Accessory Structure(Garage,Shed,etc.) $150 - Addition/Alteration to Accessory Structure $150 \ 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 \ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> IP <br /> in Unit(One Per Year) ° <br /> Six Month Camping g _$100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> C4 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o <br /> Property Owner's Name: � i I Aril 5/vi.j j,, z I <br /> 9 <br /> Property Owner's Mailing Address: / ? 3 7 EA 71 - L Al ,.i e✓ L ) 5yP6'I o <br /> City State Zip -a <br /> Property Site Address: Z ItQ yO 7 e c7 A P 14 (o c o s y-.e jr . <br /> En <br /> Contact's Telephone Number: So 7' ZS'I G Cf 5-4, iik c_, <br /> o y <br /> • c <br /> CD <br /> Contact's Email: J e 1-b r 4Y fi 3o q6 :i Hz-0-4A,A,l i co, ) 7 <br /> a <br /> 0 <br /> F_.., <br /> c. <br /> Legal Description of Property: 1-0 `(' ( Al \r!C{ p "l' Pt:_ I N rte'Stn) ka,a c- <br /> Section#: / i Town#: ye) N Range#: f y W Town of: 5( 6, 77' al i is . . <br /> S' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): ` 2 o ?i!p . <br /> 2. <br /> Proposed Use of Structure/Addition: Si.c V 41 C <br /> r c4 <br /> Anticipated Start Date: 1.70i4 e_ i 5' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: 3c' I 5 LU ,'Z d Celkyrku i Sewer Installer: ,4 / d <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** I, 1 i Po <br /> Nv04- itL,441.4111 wV$WO.;�C) <br /> li <br /> A -- cU 54cciL3 <br /> baa <br /> Fee Rec: � <br /> Y <br /> I 1, � <br /> y Check#: 15-/.� <br /> m <br /> Date of staff site visit: 51 a-5 Initials o site v' it st• ': <br /> % % <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: 5'g Pi r <br /> ffia <br /> UPON APPROVAL: APPLICAN ' UST POST COPY OF C co >, 0 <br /> a CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' m o ` , <br /> C _N <br /> Transcendent: - Page 1 of 4 i< ^' <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 2 _ Nnl <br /> . LTJ <br /> 3 <br /> -o <br />