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LAND USE PERMIT APPLICATION —Burnett County, WI g ` <br /> _ v, isj <br /> Applicant Complete All Sections Below This Line 0 <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) a W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t7 <br /> ro <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 7 ) <br /> Afr Driveways Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o b <br /> Filling/Grading $150 Boathouse $500 r• <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100f. <br /> ` ~ <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ` c g. <br /> Property Owner's Name: C i rf 4 kc L/ce... ea-4.4-o" 0z <br /> • <br /> Property Owner's Mailing Address: /703 get Lane No ri44s eId /%4 iki 53-0S7 $ i <br /> �`�� City State Zip v <br /> Property Site Address: 7;:.,dc h.41 Z-01" t/ w_ <br /> ri <br /> (�irrk <br /> , <br /> Contact's Telephone Number: ( LA-—5-1 4 /o1019 ' i:'' o gl <br /> a <br /> Contact's Email: em CO o d r.C),1 to ha-ma:/ .-Cort d <br /> FD II <br /> Legal Description of Property: G,/`ye rc..t'c Ake, 4-of ti <br /> N ro <br /> Section#: 4.2i Town#: 37 N Range#: /' W Town of: %do `a/ce 2. °q <br /> *Attach additional page ifneeded or lengthy description OR attach a copyofthe deed OR attach tax system property page.** <br /> cm <br /> PS f 8Y P Y PPt1'P8 d <br /> 7 <br /> rt <br /> Tax ID#(1-5 digit number;found on tax statement): 2 q 3 7A g <br /> Proposed Use of Structure/Addition: }me.,., `" <br /> Anticipated Start Date: 'aO-?( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> a5 <br /> Building Contractor: Sewer Installer: � <br /> -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .,--tt' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , VJ <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.** <br /> � Fee Rec: /025co <br /> 63 <br /> Check#: //2.2 <br /> /2)1rt <br /> v <br /> Date of staff site visit: I Initials of s' e visit staff: i <br /> X / =„c___J=D <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 /s / DATE: �L.2 y/ 4 • r <br /> a <br /> Gail <br /> UPON APPROVAL: APPLICANT ST POST COPY OF m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , o oco IND <br /> 2 ' 1'4Transcendent: - Page 1 of 4 • C <br /> =.Z' 4 <br /> Burnett County, WI Land Use Application—Rev 12/2020 ARI <br /> Laserfische: - w <br />