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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5" _ - <br /> pp P co <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> ,. <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 Zj- O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 U► q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 o E <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1Year Extension-Allowed Once) $100 k` <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. o <br /> • <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 s:pergolas,landscaping,etc. <br /> o <br /> Property Owner's Name: At J r <br /> 1 l `'?i. ct k, r°' /,,4/ R <br /> Property Owner's Mailing Address: Re /S (/✓' � <br /> ,' a {RC1 S �/l ie-44' /i5--3-# ; gi c 1b <br /> „-'r6 /' � / City State Zip $ 'q <br /> ! <br /> Property Site Address: �(m7 6p �r I/c lei i � +�'a y <br /> �+/1 yo O n ' , <br /> Contact's Telephone Number: •o C <br /> a <br /> Contact's Email: k 2 y. 40 tor^^ c7 <br /> Legal Description o Property: (' t ZY c54.11/07/ l/5' P/14 <br /> N '0Section#: Town#: N Range#: W Town of: z 0° <br /> aq <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): ti. <br /> Proposed Use of Structure/Addition: �l►�n t:+ �t"ds 51 y VC) `� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) /" o x <br /> o <br /> Building Contractor: Sewer Installer:A044)//94K, <br /> Cd ,m1-5-.411:,, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY/ ��. % U\ <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 d <br /> home additions, and bunkhouses.** <br /> eue-t ta 54bwaci5 <br /> M,S4- by co/1-1-q;ktej kot( via..54e vvivier or <br /> be corn %Atiky S, dc/1') <br /> j1k e(44i. - %s 15 v05��'nc4 akei,111„ZZ '5 „ ,, <br /> v v VK f 1/ 0. 6 1' ,444 g Fee Rec /C) <br /> �- V wh <br /> Ch/11Q► C Mr��” fr°. P►/e5 Fr. Check#: Cc.S Li <br /> glll� L, m <br /> Date of staff site visit: Init'• s s site visi staff: zC <br /> �j Cr) su <br /> APPROVED BY LAND SERVICES OFFICIAL: �� �0 -/' � DATE: �� � < a A <br /> i / vmC: <br /> i m co <br /> UPON APPROVAL: APPLICANT-MUST POST COPY OF a 5. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? D o <br /> Transcendent: - Page 1 of 4 n g <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < ( l <br /> v <br /> a <br /> 3 <br />