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LAND USE PERMIT APPLICATION—Burnett County, WI a r <br /> 0 b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) Q' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `, ,c, <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <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 ° L <br /> Filling/Grading Boathouse $500 --; 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ` <br /> v' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 10 <br /> Property Owner's Name: c <br /> f - <br /> Property Owner's Mailing Address:Ql ; NIOL91 -0 StRD)A o <br /> (� <br /> G Ci State Zip d 4 <br /> Property Site Address: 2� J ��i 0 <br /> 011 <br /> Contact's Telephone Number: (_ 6 l —5)-74 l'S S iwA) 1,t) ( s gra... < , <br /> Contact's Email:VEctliN teeK LorWra beeO cj a,( 1 . cV 1' c1: . d <br /> CD <br /> Legal Description of Property: L t 2- C-Stsk V 11 'P(1(P 54aO t p <br /> oZ o . <br /> Section#: � Town#: �g N Range#: (.7 W Town of: ISN I�5 0. <br /> OCI <br /> *Attach additional page i needed for lengthy description OR attach a copyofthe deed OR attach taxsystem property page.** c <br /> P S r S Y P ,t P P tYP % t7 <br /> ki- <br /> Tax ID#(1-5 digit number;found on tax statement): �-`[ 2-. <br /> Proposed Use of Structure/Addition: y y <br /> Anticipated Start Date:`(ALtA 1O.4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o, x <br /> Building Contractor: SEA,.F Sewer Installer: V 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY S_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I„) <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to .....r.._ <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home ad itions,and bunkhouses.** <br /> Owe+ a.41 Sekcilt-S <br /> .. Fee Rec: <br /> /067 <br /> Check#: stoi <br /> L <br /> Date of staff site visit:7//5/ <br /> /S//al / Initials of e visit staff: <br /> rri <br /> APPROVED BY LAND SERVICES OFFICIAL: /7 DATE: 7/16(1)—( ° e <br /> c ; <br /> UPON APPROVAL: APPLICAN UST POSTCOPY OF <br /> i(7) i 77,!i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g2N 9 <br /> Transcendent: - Page 1 of 4 `� + � <br /> Laserfische: - <br /> Burnett County,WI Land Use Application—Rev 12/2020 <br /> b <br />