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ro <br /> LAND USE PERMIT APPLICATION—Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 5' 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 /> F <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ;I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 ^ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< p (. • <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. E. --- <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 /> o <br /> i• <br /> Property Owner's Name: (' rt&l 1 t 1,1, z <br /> 9 <br /> Property Owner's Mailing Address: $ 7j La•3t'Aerr �k,v, vas- - 13)-7 2.g <br /> City State Zip <br /> Property Site Address: P' <br /> IZ Z- i <br /> Contact's Telephone Number: 6\ 7 7 �3 o c <br /> 1 P. <br /> a. <br /> Contact's Email: ,s ,,,,..yfyrk e. \ , cofj1N, i7 <br /> Legal Description of Property: 74?V /of 2 /fiS ciG of <br /> 0 act <br /> #: 12 Town#: 38 N Range#: 17 W Town of: A AQ,'f =_ <br /> *Attach additional page if needed for lengthy description OR attach a copyLof the deed OR attach tax system property page.* od <br /> Tax ID#(1-5 digit number;found on tax statement): 2(23 <br /> Proposed Use of Structure/Addition: $%O R 4 6- 6 . <br /> Start Date: <br /> .- <br /> Anticipated <br /> g—�^ � 0 �� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: .S S L F Sewer Installer: p ' <br /> " <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <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.** Po <br /> erh e e� a(( 5C c <br /> a <br /> N 04-- ti�, hat D + ° <br /> n Fee Rec. l5"/) <br /> i Check#: 57 c7 <br /> tr I Avi 1 in/a <br /> Date of staff site visit:7l2i7 I d- I Initials of Ile visit staff: z <br /> � /, / <br /> m r <br /> APPROVED BY LAND SERVICES OFFICIAL: '- i a - DATE: 7`30 < s e U` <br /> UPON APPROVAL: APPLICA ,ff UST POST COPY OF a 1 5 r' <br /> 2sl __,. L . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . " <br /> °z oo <br /> NJ <br /> C., C <br /> Transcendent: Page 1 of 4 N m. <br /> " <br /> m <br /> Burnett County,WI Land Use Application—Rev 12/2020 <br /> rt cc. <br /> Laserfische: - 0 �� <br /> a <br /> b <br />