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LAND USE PERMIT APPLICATION-Burnett County, WI ro <br /> N m N <br /> Applicant Complete All Sections Below This Line �+ <br /> R.Permit Types and Fees:(Please,check appropriate boxes) a (f1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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, '-, 6-1—i <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(1v)Structures $350 ° t3 ice', <br /> Filling/Grading $150 Boathouse $500 ``�T`` T <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ^ , <br /> un (1. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g r°^ <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 <br /> 7 such as:pergolas,landscaping,etc. <br /> Property Owner's Name: PGt-f"r i C i 4 A 14 r t 1rl e v1 z <br /> 1 L_)I 04Property Owner's Mailing Address: b 1 L( be k)i 1 S tie-OAtUe .Q!' 5 3 $ <br /> City State Zip $ <br /> 15 <br /> Property Site Address: Ra - !of bPh I/(t (API D I V:I 0-4 k-e. Peek- <br /> Contact's Telephone Number: ii C- C/C — `'j J I S ( Dam }- fit e. ) o <br /> S. <br /> Contact's Email: 17it t, b-fYi soli IQ tA.). LIS d <br /> Legal Description of Property: Cl!<T� ..V <br /> llZ <br /> Section#: O17 Town#: cocN Range#: /L W Town of: dad o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0 <br /> w' <br /> Tax ID#(1-5 digit number;found on tax statement): .' I <br /> Proposed Use of Structure/Addition: I-�-C vn`�I:'C{c <br /> :�� c <br /> Anticipated Start Date: / - (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) J`'� i <br /> Building Contractor: (J i (\ c�,l ra rki..P(' Sewer Installer: W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 n <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z ^--1� <br /> home additions,and bunkhouses.** P° <br /> 0 flcottel I iexce, 3 b i),e/A-S per <br /> 4 tv 3 3 (c,(÷ <br /> 9yce4 acs 5e-t boiciA-5 <br /> g Fee Rec: 3w-' <br /> L ,rd, #: XY <br /> WI <br /> Date of staff site visit: 6//511 <br /> ( Initials of ite visit sta • <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 6/15/?/ rn <br /> S Q <br /> A <br /> UPON APPROVAL: APPLICAN UST POST COPY OF ti a 511 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <co z <br /> .4 a) - o [nr <br /> N <br /> Transcendent: - Page 1 of 4 v 9 — r� <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 1 N <br />