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LAND USE PERMIT APPLICATION - Burnett County, WI cr b <br /> F 11,4 <br /> Applicant Complete All Sections Below This Line 6. <br /> Permit Types and Fees:(Please,check appropriate boxes) n' p, <br /> d r-- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 g. ,J <br /> i Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �- <br /> IN Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 • cO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� '- G <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ZV� , <br /> Filling/Grading $150 Boathouse $500 r <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 2 V <br /> Property Owner's Name: ./)IC 414 6.7Z- OI /p 14 o ; <br /> l f• <br /> Property Owner's Mailing Address: 2 Q "�� s--- -to f,(1 E RD' D 4� .UQy 0 `� y�3 oil <br /> P.... ity State Zip <br /> Property Site Address: 3 Z'T) — t W£i R Co a• <br /> Contact's Telephone Number: `7)C - -1CI I - DOD <br /> O ti <br /> co <br /> a. <br /> Contact's Email:AS P)k& 6 6 <t IV CLI 1 ►Y . fl cop <br /> Legal Description of Property: (DPI P1/-`' ) C 2 LAS LQ"r it/ <br /> r_ N b <br /> Section#: Town#: 41 N Range#: /W W Town of: S - ISS 0 °c <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> 7 <br /> j <br /> Tax ID#(1-5 digit number;found on tax statement): a �p 1 / . <br /> s <br /> Proposed Use of Structure/Addition: 6 ' "' <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) i7— E m <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <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 v <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** k,b,A-Gdivv) Po <br /> lJ N0'- �( h.,6,14,°� <br /> a o'le&r 04 5Ckbacks> <br /> = Fee Rec...1. --- <br /> .1 <br /> y Check#: .2.(acq <br /> Date of staff site visit: Initials of site visit sta f: m <br /> �1�91d-1 <br /> C3 i <br /> APPROVED BY LAND SERVICES OFFICIAL: At' /'-ii <br /> ' DATE:L(30 �1 <br /> UPON APPROVAL: APPLICANT FUST POST COPY OF Ui 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - -0- <br /> SIGNED <br /> g <br /> Transcendent: - Page 1 of 4 ," -- <br /> Burnett County, WI Land Use Application-Rev 12/2020 '�� in <br /> Laserfische: ��� <br /> 3 <br />