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LAND USE PERMIT APPLICATION-Burnett County, WI a <br /> cn IN) <br /> Applicant Complete All Sections Below This Line °• <br /> co I <br /> Permit Types and Fees:(Please,check appropriate boxes) °'C C-31 <br /> - <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F4 r- ,-,. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 09 c <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ri i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 p, <br /> 0 'V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 << <br /> Filling/Grading $150 Boathouse $500 • <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: A O I-4y ci- yL e- 7- 4.:-TS/-4, y '" o <br /> ut <br /> Property Owner's Mailing Address: y S / / (/J LilitC VO . g N <br /> City S to Zip $ 9 j <br /> Property Site Addressa ' P/J i g -4/I/ L EY <br /> Contact's Telephone Number: 6) / O 0 o .....\ <br /> Contact's Email: & T—E 51<' /& M03 6 12..5/4(P(f o/2 F, C`0 iiLi d <br /> ..... <br /> CD r6 <br /> Legal Description of Property: Cj C /99 L//lr/ .� <br /> N -o <br /> Section#: Town#: N Range#: W Town of: =. °Q <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> P. <br /> Tax ID#(1-5 digit number;found on tax statement): 5Q/i' <br /> Proposed Use of Structure/Addjtion: - C I-1 C c4 <br /> H ti <br /> Anticipated Start Date: F//0 0 / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y 5 <br /> G'f/W t/L j�2.ccgsH i � f7 d <br /> BuildingContractor: �' Sewer Installer: � ��//L!s f ��'' <br /> // 3 - CO 4 (., <br /> AREA BELOW THIS LI?E FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 c <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 4. v <br /> **77ze applicant needs to contact their I.DC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings, dwelling dditions,man zfactured homes,manufactured z <br /> home additions,and bunkhouses.**** 3 beot roe)SNS Fi er co <br /> 0 Dt,,,,ei 1 <br /> etc - <br /> 5AN `651)-65 '.s <br /> 4) M4e,4- QU 5e1 <br /> Fee Rec:3 D <br /> 11 <br /> N Check#: 3$O'' <br /> /-**--- <br /> C=I rn ZJ�sNb&it <br /> Date of staff site visit: 6,111/a""( Initials •f site visit staff:A -/ - % <br /> nt <br /> APPROVED BY LAND SERVICES OFFICIAL: , -, i� DATE01167)i �< <br /> gill <br /> UPON APPROVAL: APPLICA 'T MUST POST COPY OF $ - F- TR <br /> 0SIGNED PERMIT APPLICATION IN PLAIN SIGHT y w <br /> /� <br /> Transcendent: - Page 1 of 4 �'� CI <br /> � zQ GV <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 x l <br /> 0 <br /> -i J <br /> a <br />