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LAND USE PERMIT APPLICATION- Burnett County, WI c <br /> . -_ - b <br /> Applicant Complete All Sections Below This Line ov o' <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> - Dwell ing/Pri nci pal Structu re $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 $150f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 o I <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(pe rmit aqui red 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. - r <br /> Property Owner's Name: /14e,,‘ L 8E00_44 - z I� <br /> OJ , <br /> Property Owner's Mailing Address: (9/8' S 4,:s,11-- C e'o;,r SI- Rcx,ey.//4. Mii s-5—ll 3 0 aCity State Zip % <br /> Property Site Address: 3o 444' Gv4)w17r k( A S e•e• a); 4-2-1VO( =• n <br /> c <br /> Contact's Telephone Number: (p c - 6,6 - 4/'lc( l (051 32 4 - 4 4 o h <br /> Contact's Email: bbq+-eJe Q Fr-C)40(‘mal t • CoM M 21. <br /> Fi <br /> C7 <br /> ►^ 1 a: <br /> Legal Description of Property: i--C.r t C S m 'f 1") f 1-5 --- <br /> Section#: i9' Town#: 40 N Range#: ( 4{ W Town of: SG.p -f{- <br /> 5' <br /> *Attach additional page ifneeded or lengthy description OR attach a copyofthe deed OR attach tax system property page.* °C <br /> P S f lengthy P Y P P t3'P .� d <br /> Tax ID#(1-5 digit number; found on tax statement): /9.27 q T <br /> `/ �' <br /> Proposed Use of Structure/Addition: A dot;4_,,��,. (Je-.-k 'e. � L4a ..�. b,.,,,f,-ii- . <br /> Anticipated Start Date: �ye/;toaI (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> . � <br /> Building Contractor: / r 6 49,,,,..d-e ,I I, Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> CS.!4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDClnspector 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 /> red becL 4,0jer 5N 5.6 z�1viel!t el-a- V <br /> n � <br /> 0 ` [kol� !.0.'t'. ow°n M. l 34�'- P A ki r�eerne <br /> " _ <br /> _ Fee Rec: <br /> � <br /> _ <br /> Check#: <br /> / 'i.) <br /> Date of staff site visit: s(!g l -1 Initials o site visit staff: /V, > <br /> APPROVED BY LAND SERVICES OFFICIAL: %,:,., / ,..4.0 DATE: Mr71 <br /> -71 <br /> i <br /> UPON APPROVAL: APPLICA I T MUST POST COPY OF t� n "Aii <br /> SIGNED PERMIT 46 . <br /> p ' <br /> APPLICATION IN PLAIN SIGHT o <br /> cSF C <br /> Transcendent: - Page 1 of 4 ot`< <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 1Ii iik <br /> -s <br />