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LAND USE PERMIT APPLICATION - Burnett County, WI 6 <br /> r b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) °R. 01 <br /> DwelIing/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 , ei <br /> / �Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \,..., — a <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk _Bunkhouse $250 <br /> G) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 I. \— °� -'` <br /> Filling/Grading $150 Boathouse $500 o tO <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I d o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ^„ <br /> PropertyOwner's Name: a '( r/ 6, 11) ; , z . <br /> P <br /> PYGpc'i'y'Owner's Mailing Address: <br /> ;7, - I( FOX' r 4 9 P � �y 3 �— <br /> / City ‘4.) r---Property Site Address: / # / Fc, )c 'd 61,-k 2,,, �k• k S ?te .Zip(�' = 9 <br /> Contact's Telephone Number: 715-J i 7 7 vo •o N <br /> Contact's Email:J 1) $ rooc...t.loy,,i,.„, • coin -.6 D <br /> Se� 5-'2--.� 5' <br /> Legal Descri tion of Property: <br /> Section#: Town#: y 0 N Range#: 15 W Town of: Ta C ks°i'7 <br /> Naq <br /> R. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> J.. <br /> Tax ID#(1-5 digit number; found on tax statement): 3I q �, <br /> Proposed Use of Structure/Addition: G44S v A <br /> Anticipated Start Date: Citi.Li Lf ' <br /> I��(Home/Cabin;;Commercial Business;Bedroom;Deck;etc.) c ' <br /> L £ x <br /> Building Contractor: :'F 1.t.�` k 1 /5Sewer Installer: )(iSTi 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (1 2,1\1 <br /> ---' <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed front them prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z \" <br /> home additions,and bunkhouses.** // I C I� (1 <br /> 0 I le.e4 c N 4-� G14-5 V�r_ (i J--.„ <br /> 0x;,,,, CieJe It 14 ?°I b �a be- c V� <br /> . �c ec( a- b m.±?0,_ <br /> giLe„ip <br /> all #4(44Z- <br /> It, ^ `' _ Fee Rec. <br /> 'v be 1 4444 c70� F U Check#:06_51) <br /> Date of staff site visit: 7/12.0( <br /> Initial of site visit staff: �` <br /> sz r <br /> APPROVED BY LAND SERVICES OFFICIAL: /,-., DATE: b < P <br /> Fi a t_ <br /> UPON APPROVAL: APPLICA MUST POST COPY OF W r- C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - `� <br /> � ' <br /> Transcendent: - Page 1 of 4 x so'< < <br /> Laserfische: - Burnett County, WI Land Use Application— Rev 12/2020 < a (--- ___ <br /> 0 <br /> fAD <br /> K <br />