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LAND USE PERMIT APPLICATION - Burnett County, WI a c <br /> w <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Please,check appropriate boxes) <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 l" <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/industrial) $200 Addition/Alteration to Bunkhouse $150 `\ `1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' <br /> G] <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ) ' <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee, I CC <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> ‘< t <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: P/91•1 `4- &Z(D t"E% Xi F t'((//2)) - R p 1 <br /> Property Owner's Mailing Address: R 2, -0 S H c Nt R 0)c/it" 51- Ai E $ <br /> f City State Zip <br /> Property Site Address: 7Q 9 PSV i LS LIe- b Ifn�r L, K / /0 s.0 3 o G/ g. (� <br /> �y �Tb <br /> Contact's Telephone Number: 4(2— 9/0 - -f 4 / C <br /> C 1 � <br /> C <br /> Contact's Email: 13 {1( e Fut LL/F.S Vj t/y0O , CO -1' <br /> o v <br /> CD <br /> Legal Description of Property: -5 e £ ell-77,7 e//y4'p <br /> Section#: Town#: N Range#: W Town of: <br /> N rx <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 1 i.-4 4 T7o4e ic, <br /> Proposed Use of Structure/Ad ition: /46 0"1 '4 <br /> Anticipated Start Date: 9- 41 z / (Home/Cabin;Commercial Business;Bedroom;Deck;etc) x <br /> Building Contractor:eHaa E(L 3 i2 t't?/C5/67i• Sewer Installer: /1 O T/L//1/4.1S 5. `- 6- d <br /> / S-- 7 3 - o� -� d <br /> AREA BELOW THS LINE FOR LAND SERVICES STAFF CONIMIENTS/CONDITIONS ONLY <br /> THIS PER1tiMIT 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 1 <br /> A'M'Y construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z W <br /> home additions,and bunkhouses.** <br /> rneei- 411 s�- S l a///2.1 0i n a l/ <br /> G� 4o t <br /> y lo-s O ���a J <br /> P3, Pi XPi, a7s, <br /> i.0,,veli;ict IcJv e. 3 t'7X��.5 �� ".�"I = Fee Rec:�(�/✓llWn ‘O�S I � ✓r1r.�rW� I w✓'��- �M• a�)b11y Check#: 3& 3(12 <br /> f �- J _ R� l.bDate of stae visit: 7l 7� a"I Initia of si 'visit ff: <br /> 1 4 =„L: JD <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 ,/ DATE: //bJ? <br /> UPON APPROVAL: APPLICANT"BUST POST COPY OF `c ^� <br /> r (v <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ?o w G <br /> Transcendent: Page 1 of 4 �,' <br /> 0 <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 1111111 <br />