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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) n.' n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° N ' <br /> Filling/Grading $150 Boathouse $500 C. ,� j <br /> Six Month Cam One Per Year 9 <br /> in <br /> p g Unit( ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit squired 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -o <br /> o <br /> . <br /> Property Owner's Name: Pf- 5B cRi'c _V1‘X--k< <br /> `�K <br /> [ Tj o r <br /> Property Owner's Mailing Address: /,„2/5 t-Z'h ,vu)\( L-R Vi a { (.i ( `mak , . <br /> // City State Zip b <br /> Property Site Address: . <br /> E <br /> Contact's Telephone Number: 3 k ' 3 . -5-611 ', \ o F, <br /> Contact's Email: R i(e_K,rz 7 ct'Mack k\ - C r-nn y <br /> r <br /> Legal Description of Property: <br /> Section#: o(. Town#: �► N Range#: /2 W Town of: OA K Lif ril\1 <br /> N aro <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* °G <br /> r ,. <br /> Tax ID#(1-5 digit number; found on tax statement): /3t 7 <br /> Proposed Use of Structure/Addition: Gt J Ecn <br /> Anticipated Start Date: -`3-a-1 (Home/Cabin;;Commercial Business;Bedroom;Deck;etc.) o x <br /> '11;:pc' ,--3 <br /> Building Contractor: Sewer Installer: C7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY uJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CJI <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to (J.) <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> ho a additions,and bunkhouses.** <br /> eek- c b <br /> t( 5 e - <br /> �� <br /> i'votf ko( it40-/A-fi 1/164, ,i,‘.20 , , <br /> po <br /> MPek- a(t ire re marts. o 4- Co ( Oc t±0ç1914 po <br /> z Fee Rec: <br /> ao <br /> / L Date of staff site visit: 7/ 2 7/ �1 Initials of s' Check#:. L visit staff: Q 1 <br /> i MI <br /> APPROVED BY LAND SERVICES OFFICIAL: �I/ //,/ �j DATE: g/�/?/ - c. c.— <br /> UPON APPROVAL: APPLICAN 'BUST POST COPY OF 4 $.9 ch N <br /> ifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z g a o <br /> Transcendent: - Page 1 of 4 m 2iiii <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 <br /> c, <br /> a <br /> 3 <br />