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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> *0 <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) a.t'. ",C J <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> w <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 Y $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150n Ji <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 w <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures _$350 ° 0 o` <br /> Filling/Grading $150 Boathouse $500 r l" i 1 <br /> II <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year 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. el <br /> r. <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 /> r <br /> @ I <br /> Property Owner's Name: rte;y e...1 Lam..4..n4, /4'e--( z C2 <br /> Property Owner's Mailing Address: T)0.1' 7 S'.-4 f. IV. /11,,„%. (rrz-e- Pin 5:57? o pk <br /> r n City State Zip $ P <br /> Property Site Address: 7 6I 5 J c�i-4 /giver Asa �00,rt L r y , Iw,l 5-ii g s'e <br /> Contact's Telephone Number: 7 6 3 - 2 7 5t y i o 2. o <br /> Contact's Email: d rt <br /> Legal Description of Property: \I <br /> N -v <br /> Section#: .2.9 Town#: 40 N Range#: I J W Town of: (/„;o.-) °_. <br /> 5 °` <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): ).5 /4.3 0' <br /> Proposed Use of Structure/Addition: l4✓A"I.j £4 s;,cx `4 a <br /> Anticipated Start Date: Avy, cll./ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E k <br /> !, <br /> Building Contractor: S t•14 Sewer Installer: /)c.l e <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 , `1 <br /> home additions,and bunkho ses.** z V" <br /> VMce - ad( <br /> Fee Re : ). C,) <br /> v, Check#: <br /> a <br /> rri <br /> Date of staff site visit: 80 I�' Initials of to visit staff:/1400 z <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: e/f /? <br /> w <br /> UPON APPROVAL: APPLICANT UST POST COPY OF , .= G' <br /> WI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTg J <br /> N <br /> Transcendent: - Page 1 of 4 ;� I; i`'' <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 <br /> L <br /> -a <br /> a <br /> 3 <br />