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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c c <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "pQ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 A' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C <br /> ti <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e <br /> Filling/Grading $150 Boathouse $500 i- <br /> ° . <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cA <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> r ''' <br /> Property Owner's Name: _6A.,,) .i.- yG YL� W J 55 f,e, ° o <br /> Property Owner's Mailing Address: a.\04-f -, Die, J tom/p /rn c Nei S3:o.3' °o <br /> City State Zip <br /> Property Site Address: X yc x RCD P1 Nit ri2A,L <br /> 4 VI <br /> Contact's Telephone Number: 7/5-- Li (7 //5 (_J 6-SSE-) . o E p <br /> Contact's Email: Svti, T ‘4.„1 to ��V9J jr,n Co v„,.., (��2' i7 r 4T) Pv <br /> e2. \ <br /> Legal Description of Property: ej ti .� ,z-- <br /> �. ,, v�,�A-1-si'1 --..45 i 1 i <br /> N <br /> vo <br /> Section#: /c' Town#: qO N Range#: / 7 W Town of: (�/(//OiC/ 0• <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): (-D-575-1 7 <br /> Proposed Use of Structure/Addition: A6 I A./ `4 <br /> - <br /> Anticipatedr.--P---Start Date: - Z. ' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �o C1 <br /> Building Contractor: c-\4 VN CEJ 5'Clj,ty.. 4trntel-Sewer Installer: , /4QJif /A./fet/VS y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY lir , T1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: * c.31 <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 ditions, and bunkhouses.** <br /> I Tee - 0,11 se-�4 c -5 <br /> -4- iv exceedr 40 ll <br /> 3 N0A- \'p e -eek 1 ( bedfoo✓rL5 ?et' 5-021 - 13 <br /> Fee Rec: 612" <br /> K Check#:/0‘9.3y <br /> 0 <br /> 7/?9 /21tz <br /> Date of staff site visit: Initial ,f si / isit staff: r, <br /> o <br /> �[ / <br /> APPROVED BY LAND SERVICES OFFICIAL: �� /,'/� DATEB�TIp�/ _< -�_ <br /> r lJ <br /> UPON APPROVAL: APPLICANT��;r ST POST COPY OF y � c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m3 r <br /> r a <br /> N <br /> Transcendent: - Page 1 of 4 i i r 3 = <br /> Laserfische: - <br /> Burnett County,WI Land Use Application —Rev 12/2020 ' °''` ^ 4 <br /> rzw <br /> R <br />