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• <br /> LAND USE PERMIT APPLICATION-Burnett County, WI a 1 <br /> Applicant Complete All Sections Below This Line 5" r <br /> iLi <br /> Permit Types and Fees:(Please,check appropriate boxes) a...•.7 <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `.�.J,+ <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n — <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn (6 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. c <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: ` a e. \ • J o <br /> tLJ� C)\ <br /> Property Owner's Mailing Address: % • dCy�. co <br /> 1� City State Zip, v $ P <br /> Property Site Address:�� 2- \" \v(-Ne C\ Lai' (C j )1 W a' r) <br /> Q j� <br /> Contact's Telephone Number: 7OT'L_ 1`12 `0v�� � m o <br /> 2. <br /> Contact's Email: J�",, , rocuGJ Y <br /> fy-11�f � i t \. a • m e Vt <br /> Jn <br /> 0 <br /> Legal Description of Property: And kVm2 <br /> NI i <br /> Section#: Town#: N Range#: W Town of: 5 °O 11 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* G <br /> N <br /> 4 <br /> Tax ID#(1-5 digit number;found on tax statement): F. <br /> 2t7) <br /> Proposed Use of Structure/Ad.i ion: At 'Ci C EC `r' <br /> Anticipated Start Date: ' C (Ho 1, abin;Commercial Business;Bedroom;Deck;etc.) <br /> izz o <br /> Building Contractor: Sewer Installer: <br /> -I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Q-) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: j' <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.** estioctck Po <br /> ItheeA- ail 5 <br /> iVo b1 LihAii (,totb; . ‘-)4 <br /> croo <br /> g Fee Rec:' / <br /> 1 0 2 Check#: y0J y <br /> m <br /> Date of staff site visit: Initials of site vi 't sta' L. a <br /> / / <br /> 613a <br /> APPROVED BY LAND SERVICES OFFICIAL: $:i DATE: Rig/2) S ---- --."G <br /> SO <br /> ffiii <br /> UPON APPROVAL: APPLICANT UST POST COPY OF y ,W v <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g H° �� fRii <br /> Transcendent: - Page 1 of 4 g c ev Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 1a'` <br /> m TR <br />