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LAND USE PERMIT APPLICATION — Burnett County, WI 6 r <br /> Applicant Complete All Sections Below This Line 6� � <br /> A <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C7 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 OG O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Z75 Pi <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk - r <br /> Bunkhouse $250 n Kat <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ip , 1 <br /> Filling/Grading $150 Boathouse $500 �. �/ <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 C <br /> CA c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. R. V <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory str res,such as:pergolas,landscaping,etc. <br /> r <br /> Property Owner's Name: _ y 1/4.) ; # , ' rev, / v " ° 0 4 <br /> Property Owner's Mailing Address: -23(e t 0 `c( �', 4,( v titiJ- L( o <br /> City State Zip -0 <br /> Property Site Address: S <br /> i <br /> Contact's Telephone Number: -1('-) Z30 Qcet ' <br /> Contact's Email: dk/lrev\a(,{ v IS Z. a `C (b O C' • C®Y'^ d <br /> FT; <br /> ..., <br /> Legal Description of�PPr perry:.nr / -1)4.11:e14' <br /> f <br /> Section#: ,rc(ti 7fo4#: /40e N Range#: I -1 W Town of: 4 h 1:e l`7 0 °G <br /> I a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0 <br /> Tax ID#(1-5 digit number; found on tax statement):, 2z y <br /> Proposed Use of Structure/Addition: ‘-;,)411-1\‘-;,)411-1\ih [h _ <br /> Anticipated Start Date: 1V{vQe‘ ome/Cahin;Commercial Business;Bedroom;Deck;etc.) 7:=) <br /> Building Contractor: K,t If Sewer Installer: Ni&"' 0 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> I'llk_0,) <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 /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** tbcccits z <br /> Med– CO S <br /> roilolA) cell 6"4A haot6 e Le,vert 4 n÷ <br /> z Fee Rec:/ id° <br /> g <br /> 1 u, Check#: ap0 od <br /> Date of staff site visit: 7// ✓/a Ini '.is • site visit staff: ' `--I (—� <br /> rw , / //'' ' r �wJGlr� <br /> Iv <br /> APPROVED BY LAND SERVICES OFFICIAL. ''L ��� i TE:0 ,67 a <br /> �W 0 <br /> UPON APPROVAL: APPLICANT : UST POST COPY OF cb x ' n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT '..; Iv �, <br /> a Z <br /> Transcendent: - Page 1 of 4 m <br /> Ina <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 12/2020 ` <br /> J <br /> a <br /> b <br />