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r <br /> • LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> N m tJ <br /> Applicant Complete All Sections Below This Line 8 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?; <br /> CD <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 1 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk _Bunkhouse $250 ~ <br /> 2Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° + <br /> Filling/Grading $150 Boathouse $500 o .� <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> A. <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ' A <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> Property Owner's Name: t ✓'k a.,i/d ,T4 (i [.I. l//t/P !TF,letr," z v b <br /> Property Owner's Mailing Address: 2/9 / ,�-.A./4"..1 <br /> j(/4".1 eMire l/T d 71 :V .j/,Gi--,$ <br /> �/ City State Zip .o b ' <br /> Property Site Address: 7(/ 3 ! �� / /a = cni, (a <br /> Contact's Telephone Number: �� J,2'8Gib <br /> Ca `moi o <br /> ,� g <br /> Contact's Email: � ? Ap 7ArA Ii: Caldf d d <br /> /' 70 R V <br /> Legal Description of Property: Z7�iJ ��Ql' {� <br /> + N ro V <br /> Section#: I i Town#: 4 0 N Range#: /4 W Town of: , �O] o 00 <br /> 5' <br /> cio <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> VI <br /> Tax ID#(1-5 digit number;found on tax statement): / 7 gi eib g' <br /> IMP <br /> Proposed Use of Structure/Adtion Q �' ja),,,/4/70use_.Anticipated Start Date: 67 ('5 2f (HoCabin;Commercial Business;Bedroom;Deck;etc.) � l f <br /> Building Contractor: Q;i^ K PIV J4op Sewer Installer: / 7� - <br /> -3 _ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CO DITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t <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 addit'' s,and bunkhouse*** , <br /> d ed- 411 Certd4 v/1 -�r�arn V ar;gfrCe— <br /> r Meef-- all 5e-1- b S },r, ecceect belm''-s <br /> 1pD,Ne ll I 4 b�k I'loLse uaf- <br /> per N- 521121 x Fee Rec:07:7 <br /> Check#:I33753g0 <br /> Lry <br /> Date of staff site visit: 6;4)i-112-1 Initialssite v'sit st ' t- <br /> , <br /> z <br /> I. , <br /> I o <br /> APPROVED BY LAND SERVICES OFFICIAL: fi DATE: 7/6/24 rn <br /> UPON APPROVAL: APPLICAN -. ` UST POST COPY OF = � <br /> w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ..� , z U©1 t1 <br /> Transcendent: - Page 1 of 4 2 o U uu <br /> Burnett County, WI Land Use Application —Rev 12/2020 'v o ti o <br /> Laserfische: ,m c N <br /> •3� <br /> mIfifil <br /> I Lc---"--JJ <br />