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LAND USE PERMIT APPLICATION-Burnett County, WI a `° r <br /> b <br /> Applicant Complete All Sections Below This Line 5 <br /> co 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) ° V <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �J g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° M <br /> Filling/Grading $150 Boathouse $500 r N �'% <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 , i <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> ru <br /> Property Owner's Name: /(os "\ <br /> e'r /9. 'f' 7;27n cc,'c . f /I/o1 <br /> r e/i"t ' ° <br /> o • <br /> Property Owner's Mailing Address: .24// Red /lint C lec% gcrc(,Jon 41X $'y0/6 0 <br /> City State Zip 'o L% <br /> Property Site Address: 2 6479 /V L i?se %' ,LA. Roe e.g-sPoen • W Z SYBo/ S' n <br /> cn4 <br /> Contact's Telephone Number: 7/5-- yq/ - //....c 7 o <br /> c <br /> Contact's Email: /"09 2!". I?O! e/1.4..s6? C► ^4ii, C 01M C7 <br /> ' <br /> Legal Description of Property: ti oy e•'.ore.,ore., ,L A o f / £1-c i'., C.r f 0r S re'coearrat# . <br /> N a <br /> Section#: 42 Town#: .9? N Range#: /y W Town of: /PI'sh . <br /> 5' <br /> *Attach additional page if needed.for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): .714/0 R• <br /> Proposed Use of Structure/Addition: ,S"i o/'a,l e and Pct r k 1 t; <br /> Anticipated Start Date: prf .2o 2/ (Home/Cobinr Commercial Business;Bedroom;Deck;etc.) � F m x <br /> Building Contractor: C.rrn,(,er/4oi A c e 1/2.,,e/4"..r Sewer Installer: - tp <br /> t7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY : UN) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> fEN <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 /> � <br /> home additions,and bunkhouses.** V <br /> Mee eta 5e L Cli <br /> 44 eek-- c( 5-e -S <br /> X' Fee Rec: /5 t <br /> 5 Check#: /4,,951?- <br /> I L m <br /> Date of staff site visit: ` d + i I Initials of 'te visit staff: Aft ,Y• <br /> - • JOOP' u <br /> APPROVED BY LAND SERVICES OFFICIAL: /j,v DATE:t/G i 26 < I- <br /> /', <br /> (� <br /> �/ m ' Uu1 <br /> UPON APPROVAL: APPLICANT�: ST POST COPY OF z co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o o �W <br /> W . c <br /> Transcendent: Page 1 of 4 m v-.5 <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 12/2020 '' 3 ..., � <br /> - <br />