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1 LAND USE PERMIT APPLICATION— Burnett County, WI
<br /> Applicant Complete All Sections Below This Line o
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<br /> Permit Types and Fees:(Please,check appropriate boxes) C7
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m
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<br /> ,Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200
<br /> I/\ccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150ik-
<br /> iAccessory structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g
<br /> I Ueck/fav�j Patio�R�ai�ing Wal Sii walk Bunkhouse $250 C
<br /> yI Unveways/&Campground Structures 125 WI State Statute 59.692(1v)Structures $350 < p,,,jjj
<br /> liilung/Grading $150 Boathouse $500 r 3„) .6-\
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<br /> c,ix Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 '� `}J
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<br /> 'NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a
<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. , II
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<br /> .rnncrty t nvncr`s Name: ♦�Sc�v� z C.,0
<br /> r,ncrty t owner's Mailing Address: 14 5.q9 C el,vv--.4 y �0_4.. INooR.,
<br /> n �1 City State Zip b
<br /> '•rcmeriv Site Address: K�AVes�,i-e& 1--- 2K-..ct, ps, \ wQ6 r W ) &I-AS F. n
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<br /> cntuct ; I elephone Number: 7l S^ 8�� -- `j 09 r°- z )
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<br /> untact s i-:tnaiI: Jel_c,K SOv,_ ' 1--,\-\ % l\f..._(,c,v c c 'v Y1 C
<br /> ..,,:.11al Description of Property:
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<br /> cutin : 3(o Town 4: 96 N Range#: /S W Town of: .So r R.
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<br /> I/roil uciduu,ucrl page it needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I b
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<br /> Ill 4,i I-5 digit number: found on tax statement): Fi.
<br /> -moused Use of Structure/Addition: `"
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<br /> \ inctpaled Start I)ate: (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) o
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<br /> Inc Contractor: Sewer Installer:
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<br /> kREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: e
<br /> ,,- rwtnu tint needs to contact their LDC Inspector to determine if a permit is needed from them prior to Q)
<br /> �.�i'tructtun taking place Or any dwellings, dwelling additions,manufactured homes,manufactured z
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<br /> Fee Rec:
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<br /> 4 Check#:
<br /> 1.:2-77 1ai ti
<br /> tate of staff site visit: Initials of s' • visit stat� / z
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<br /> 74
<br /> APPROVED BY LAND SERVICES OFFICIAL: 'A - Al DATE: 7l °�g3( ?1
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<br /> UPON APPROVAL: APPLICANT ;► ' UST POST COPY OF
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z
<br /> i ranscendent: Page 1 of 4 M
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<br /> i.ascrnschr. Burnett County, WI Land Use Application—Rev 12/2020
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