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LAND USE PERMIT APPLICATION—Burnett County,WI a r <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �tr- <br /> /- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,� `� <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `�. E <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> t7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 tp <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 a` <br /> vi <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. R. r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> 1*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. CD <br /> r a <br /> Property Owner's Name-_,5: (//� tr40/1 o <br /> III <br /> Property Owner's Mailing Address:35C AK: $lp i':',.g VC I"Ai -(101 RASE /4 J fye25 o <br /> City State Zip s <br /> Property Site Address: //. �/�/d,0�O ` <br /> D �/7L1CL LIOI�L� L✓� SL�6�`?f 67 ri <br /> rr) <br /> Contact's Telephone Number: 16-5/ .267 a/27 o <br /> ia. <br /> Contact's Email: s94 9.93 / mfl <br /> i L , coCQ ii <br /> Legal Description of Property: ,..5-2/"'/ P9/) R/v1,/ ,L 7N Ai Air .crick: <br /> `J <br /> 1.� N <br /> Section#: 3 l Town#: 3 0 N Range#: 1 W Town of:tA(i,� . <br /> 0 irc <br /> *Attach additional page lf needed for lengthy description OR attach a copyqf the deed OR oboe tax system property hPage.* O <br /> R. <br /> $ <br /> Tax ID#(1-5 digit number;found on tax statement): ' " 7 <br /> Proposed Use of Structure/Addition- 5-14e P i17' r" <br /> Anticipated Start Date:7/2 (Home/Cabin;t Commercial Business;Bedroom;Deck;etc.) k <br /> Building Contractor:, l�yAP 14 r II' <br /> Building sy. Sewer Installer: /j/ 8 <br /> 9 W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O1 <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** z <br /> Mee+ all Se- S • ,�, <br /> 5.y) -W C1n Lie-k 'lar 4;5 5 Y'Q" <br /> 3rno✓e rsscu <br /> g Fee Rec: 1.d <br /> f M Check#: /// oL <br /> c. <br /> Date of staff site visit: 76 /�I Initials o site visit .: .f. v `U <br /> qP <br /> APPROVED BY LAND SERVICES OFFICIAL: Cto / DATE:"� <br /> UPON APPROVAL: APPLICANT/ UST POST COPY OF �C7--J <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT qi co <br /> r , <br /> Transcendent: - Page 1 of 4 0 co �7 <br /> Burnett County,WI Land Use Application—Rev 12/2020 5 0 c� t!uU <br /> Laserfische: - H m°e r.,,,,,. <br /> CI <br /> H m C: <br /> 3 <br /> 0 <br />