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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Ihch <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> )C. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° Ivp ib <br /> Filling/Grading $150 Boathouse $500 r 1) lb <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> '� oo <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <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. <br /> � . . <br /> �meS Wade_ <br /> Property Owner's Name: cu 0).-1y,S Q in o <br /> Property Owner's Mailing Address: <br /> 2 32 , 9 le4-, Sf. HQs l°/)e in X5j3 <br /> pity tate Zip $ ► <br /> Property Site Address:g 9 7. <br /> Li 20 PC?r� 7 on , y 1 �e z <br /> Contact's Telephone Number: 65)- 970 36' 00 o_ N <br /> 0. <br /> Contact's Email: (hid <br /> 1 w <br /> Legal Description of Property: L G�J- 7 (' S M //9o <br /> / l .. <br /> Section#: i Town#: %40.,_N Range#: �h � <br /> W Town of: �{ <br /> 0` <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa e.* <br /> P <br /> E. <br /> Tax ID#(1-5 digit number;found on tax statement): /50 ?O <br /> Proposed Use of Structure/Addition: 0(If BO li)�iS <br /> Anticipated Start Date: (Home/Cabin;CommercialBusiness;Bedroom;Deck;etc.) o A> <br /> Building Contractor: _ )'7 S )j Ort Sewer Installer: c)(� ,'i Usj <br /> r7 <br /> f -� <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 <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions, and bunkhouses.** PJ <br /> 17 pep 4- ( hAiNe,b, N;0,-) <br /> OP Mee- QII Se-1-4. s <br /> 0 No+ 4z, eXc.,e cot iicA4-- ;4 lit tib- <br /> x Fee Rec: I <br /> /`^� <br /> V2 Check#: &„J il <br /> rii <br /> Date of staff site visit:46117!2-1 nit”•ls ,f site sta f: 1-4-- z <br /> 0 /• / r <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �l�-3/a <br /> m <br /> UPON APPROVAL: APPLIC A MUST POST COPY OF hI € <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 � Q 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < G <br /> m <br /> o `1-- <br /> a <br /> 3 <br /> �a <br />