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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' 0 - <br /> Permit Types and Fees:(Please,check appropriate boxes) 0- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `"a <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <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 . <br /> Filling/Grading $150 Boathousepl <br /> $500 r r 0 <br /> Six Month Camping g Unit(One Per Year) $100 Permit Extension(1 Year Extension Allowed Once) $100 ‘, <br /> in <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. $pi <br /> pi <br /> *Items not listed above will be treatedeaas accessory structures,such as:pergolas,landscaping,etc. -o fip <br /> Property Owner's Name: �1`t'�j�e. /114-.1_.6.4,../ o � -'_v <br /> Property Owner's Mailing Address: -3 415,2/ �y ic�t e/c few 16-71-i) k i Gnz 1110' <br /> M //�/ City -7.- Stat y8,30� a <br /> Property Site Address: 3 O 4 5 a l ,,,t c G/-iz 440,.4 ;,,ti , 7 <br /> ED <br /> Contact's Telephone Number: 76 5--- '7eY�-0 710 o <br /> • 0 <br /> CD <br /> Contact's Email: S _ '*L / 7/4 Ca-- y'0/,-,'L , co--- a <br /> Legal Description of Property: ,A-t^ A 6Si'1 /A-417 if 7-7, .2S1 <br /> `� o 00 <br /> Section#: T Town#: 4ll N Range#: W Town of:,S.1.'/SS 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> E <br /> Tax ID#(1-5 digit number;found on tax statement): .2 iS C 2 <br /> Proposed Use of Structure/Addition: iclik S/.46 6 e_ Cl, <br /> Anticipated Start Date: 4al Is, 2 v z i /(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 7 E x <br /> Building Contractor: 4.e r / ,i,'.J Sewer Installer: <br /> -3 <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 V <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z e <br /> home additions,and bunkhouses. ;v Y <br /> $ftlee.4 q It 5 ek S <br /> N by be r h� a� hGb,` `c)vl <br /> z Fee Rec: 1 5D4P-) <br /> V N <br /> Check#: l3,2,78 <br /> (:)041 / -101 <br /> Date of staff site visit: Initials o site visits z <br /> / v , <br /> APPROVED BY LAND SERVICES OFFICIAL: , rV DATE:77,67? l n <br /> n R <br /> UPON APPROVAL: APPLICANT UST POST COPY OF yactt <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y 0 t[—uti <br /> 'ag Ps, o <br /> Transcendent: - Page 1 of 4 .A� e Q <br /> ", Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020m <br /> a Viii1",== <br /> • <br /> b <br />