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LAND USE PERMIT APPLICATION - Burnett County, WI cr 2 r <br /> b <br /> Applicant Complete All Sections Below This Line 6" G <br /> r 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) o- <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 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 tO O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 U <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures < a <br /> y pg $125 WI State Statute 59.692(iv)Structures $350 < Q <br /> Filling/Grading $150 Boathouse $500 r= <br /> Six Month Camping Unit(One Per Year) $100 A Permit Extension(1 Year Extension-Allowed Once) $100 0t5_ <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. w <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 /> c, 2 1 't\ <br /> Property Owner's Name: ' '`'' "' Ak-- /,-09e,p) z <br /> 0 <br /> Property Owner's Mailing Address: -7 yy S4'''; CAS Dr Oni- ,04 c�0-3 3 0 <br /> City State Zip o <br /> Property Site Address: ' t.( '' ‘ 7)( er IaCt rA vChs v5 <br /> c) <br /> ivy: l� j� < <br /> Contact's Telephone Number: �I�-�`�y' �/�% �'�y� �,�� -510 � o <br /> Contact's Email: ` C.d <br /> Legal Description of Property: LST a 0,4 O-P\ OP-,1 1' Y15 `' ( 61_9) \ <br /> co <br /> N *o <br /> Section#: —4 Town#: LION) N Range#: (S W Town of: .Ncv-k St v' 0 °C <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement): S 11 g' <br /> Proposed Use of Structure/Addition: ( I " "4 v' <br /> Anticipated Start Date: ca.;i4td1,o`,1\ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o ' <br /> Building Contractor: Sewer Installer: (AlAik, i)NV'(-4.19G1"--, ^°�, <br /> H C— V, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , vt <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 /> til <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z Q <br /> home ad ns,_and brtkh1 i �ortI ** I rho <br /> A5 ' pe("--1-- <br /> z <br /> UV CG1/4-b' ' / op V <br /> x Fee Rec.� <br /> N Check#:_ <br /> / 0 <br /> Date of staff site visit: 913 L Initials o ite visit st•�!!�� z <br /> APPROVED BY LAND SERVICES OFFICIAL: L DATE: 8(64:3-1 n a <br /> a c.... <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a � <br /> I - <br /> ,,, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . <br /> 0 o <br /> 1, N <br /> A <br /> Transcendent: - Page 1 of 4 n '" <br /> Laserfische: - <br /> Burnett County, WI Land Use Application—Rev 12/2020 r., a _ <br /> m t1 <br /> a <br /> K <br /> -o <br />