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LAND USE PERMIT APPLICATION - Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line ' c b <br /> Permit Types and Fees:(Please,check appropriate boxes) a.tj U` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w ^ .t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 9.1 9 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G-. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° lj <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 /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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. 1 <br /> _ r i <br /> Property Owner's Name: xc f',--1, <br /> .y�ti 1 . 9- /e r C S c, A. Pc4 r A u s o <br /> Property Owner's MailingAddress: S".`/d.,•) o v) <br /> p 63 �d ilc�r sf, �!'�sc�nf� to' o <br /> City State Zip a. <br /> Property Site Address:g'7615 /V. ,05t Lair 1Q&, /) 0,4-'4 CA r f 1 WI _S�'y g3 D 5- n <br /> Contact's Telephone Number: 71 3- y 9 J _ e 1/0S— F, ' <br /> ir <br /> a. <br /> ilo <br /> Contact's Email: k p€t'hus C•en}tx.►r.l)irk.Its-NZ} d <br /> Legal Description of Property: <br /> N Section#: Town#: N Range#: / W Town of: a ro <br /> > y �oU �.�`v ti O <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 /> v <br /> Tax ID#(1-5 digit number;found on tax statement): d. zy 7 r- ? <br /> Proposed Use of Structure/Addition: 5 A e A , 5)10 r, cr e <br /> Anticipated Start Date: J©- AS--;2d A ) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> o o <br /> Building Contractor: .410/-)14 I m.c . Buil,)p,-„4-,5Sewer Installer: /L� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> "r \-') <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.** 7y <br /> IP Yhe�ek- aw.....64.,JJ sv10 <br /> 64 Mali .�✓I <br /> 0 iki e4 (O {dAS A o(1St <br /> C b hl!ItAi <br /> 0 ee wo V 5e- Qrp x Fee Rec: <br /> t•••‘) (cuced'K � QTU0/ 905- ly 0 1 I/2' 1 7, Check#:jcPcM <br /> 0 <br /> tri <br /> Date of staff site visit:i3/3// I Initials of site visit St. z <br /> A a / / �� /�/ � 0 <br /> Q <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: ea / DATE: < r. <br /> m c tiiii <br /> UPON APPROVAL: APPLICA MUST POST COPY OF m W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo �. <br /> Transcendent: Page 1 of 4 m o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < S <br /> a -is <br /> 3 <br />