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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> c7 c7 tj <br /> Applicant Complete All Sections Below This Line �' <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> • Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d r , <br /> 6�Q <br /> Commercial/Industrial Structure , $ Addition/Alteration to Commercial/Industrial Structure $200 1..� �+� <br /> ! Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I <br /> Accessory Structure(Commercial/Industria Addition/Alteration to Bunkhouse $150 OQ 2, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .40 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ‘ <br /> Filling/Grading $150 Boathouse $500 r- I <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 0 ' lb <br /> *NOTE:After-the-fact permits(permit aquired 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. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name:Tell LI r1 C4;"lic/ _ s z <br /> c r1 <br /> Property Owner's Mailinc,Address: ? 0 , 60 X 1 -- �An e'k&„ (l L) SS,3 0 3 o 11 <br /> 2 3 t{ A City State Zip % <br /> Property Site Address: U it Se 4 4,-,d,I k.�('. \Cj{t. t O ike fin;`1 `,-4k 3-1 B' P <br /> Contact's Telephone Number: 1 3- i ri - 1 Cr G G ° c <br /> , i a <br /> Contact's Email: \ lac'. J roo-k- D- .et---, t o,1 Mc&, 1 . C O ;v, p <br /> Legal Description of Property: LI. k <br /> N ^o <br /> Section#: -\ Town#: N Range#: W Town of: a " <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number;found on tax statement):_ 9 3 0 ( F' <br /> Proposed Use of Structure/Addition: •- fir CL&r , "' <br /> Anticipated Start Date: Home/Cabin;Com tial Bus' ss;Bedroom;Deck;etc.) Ex <br /> W `v <br /> Building Contractor: — Sewer Installer: <br /> I1 v <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 /> —4- <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions, and bunkhouses.** z <br /> f1.ee# cal 5e-F .c15 ' <br /> pfVo- - 4 ( 1n/qfl hb14- ' ' <br /> _' Fee Rec: /` j:1-) <br /> qb-d-I <br /> � v Check#: /J/Date of staff site visit: A iti• of si e visit staff: > <br /> .,z • <br /> Jr /- <br /> cr <br /> APPROVED BY LAND SERVICES OFFICIAL: res; . ,j -/ DATE:jidr( l,) i <br /> �_�-^+/ <br /> UPON APPROVAL: APPLICA MUST POST COPY OF 0W 0 <br /> 3SIGNED PERMIT APPLICATION INPLAIN SIGHT 12...O SG o 0 <br /> Transcendent: Page 1 of 4o Q <br /> Laserfische: Burnett County,WI Land Use Application-Rev 12/2020 <br />