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LAND USE PERMIT APPLICATION - Burnett County, WIcr <br /> cn IN) <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures ° <br /> y pg $125 WI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r- <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 aqui red after construction has begun)may cost up to three times the normal fee. i <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ro <br /> CkV21S+ ( Phe�r,e.t-6� . V <br /> Property Owner's Name: z <br /> 0 <br /> Pb LA 102 Web5ie r w 1 5�S3 -.Li <br /> Owner's Mailing Address: g 1 <br /> (c)SCD <br /> G 1 /� City State Zip b 1. <br /> Property Site Address: �O� C R a Pr ) V''Q sk r,%►A 1 54 9-7---) E. 1 <br /> Contact's Telephone Number: .1 lc '`l--)J' '--001 1 o i k <br /> Contact's Email: a t(�Y1 Cil CS a k'r�""` 60' • ( fWI" d <br /> ro <br /> Legal Description of Property:1.-cT 2- CS t'bl,J 4131 z 6 P2i 0 yn(oV 1 Or 2 J'* 243.-' -' 1 <br /> 0 oc <br /> Section#: O3 Town#: -Jci N Range#: I to W Town of: �e.-rl lin 0 <br /> S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number; found on tax statement): 1 1 0 <br /> Proposed Use of Structure/Addition: YTiCa-e- cn <br /> Anticipated Start Date: b -- IS - (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o k <br /> Building Contractor: Sewer Installer: <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 O <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z --S <br /> home additions, and bunkhouses.** <br /> (►dee'- &AI 5C1' <br /> ibi) V vol- ca k44'-4/ I4441 A--%1 1 <br /> = Fee Rec: f — <br /> Check#: <br /> �li7lacrti <br /> Date of staff site visit: Initials of s' e visit staff , � z <br /> / /Q <br /> APPROVED BY LAND SERVICES OFFICIAL: ' , w j// DATE: 8l` l 7�l m <br /> UPON APPROVAL: APPLICAN" MUST POST COPY OF a a iffl <br /> G-7, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r o N...,o r <br /> coc <br /> Transcendent: Page 1 of 4 m SD , <br /> Laserfische: - Burnett County,WI Land Use Application -Rev 12/2020 <br /> o <br /> a <br /> 4, <br />