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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes) o. <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m <br /> E <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `� .9 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° N <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 aqui red 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. <br /> Property Owner's Name: k •A • U . , C t C d C,/ C u • 4 ,. . IYK z <br /> 7.1 <br /> Property Owner's Mailing Address: 9-7 3.S-- © / cl}} <br /> <. c3 S" S ` < ,Th e , ' J , 8'7 <br /> 0? °o II ^ <br /> ` City State Zip a <br /> Property Site Address: a Li 9 6 I y b u..�`C c LkC� /....."1 n e a' <br /> / • <br /> Contact's Telephone Number: 71 5 —< 7 S "- 3 CGI o <br /> C <br /> a <br /> 11 <br /> Contact's Email: d <br /> Legal Description of Property: <br /> 0 cx <br /> Section#: 3! Town#: 3 5 N Range#: /4, W Town of: YY) e e n c, _ <br /> °q <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> p <br /> Tax ID#(1-5 digit number;found on tax statement): / a Q / / 0' <br /> Proposed Use of Structure/Addition: 5 k e-. c�,-t\-, S p rt d At c(0 c; e-L.4/Oc„r <br /> Anticipated Start Date: , , 4/(7/a/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) £K <br /> Building Contractor: eC� C re,-t g.-1---t"J, i Sewer Installer: X)6 n e__ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 r� <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** ,7:1 <br /> lip (peek- a.Il 5e„ NA ,Q.0( ji,iinotil , <br /> iib,-ice.1 <br /> x Fee Rec: <br /> 0 <br /> Check#:3C-1.% <br /> � <br /> Date of staff site visit: 9/11 Initial of <br /> e visit sta : . <br /> APPROVED BY LAND SERVICES OFFICIAL: .� / // f g/ m <br /> ffflil <br /> UPON APPROVAL: APPLICANT;;' UST POST COPY OF coEF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o G <br /> Transcendent: - Page 1 of 4 ,� <br /> Burnett County, WI Land Use Application—Rev 12/2020 <br /> .,...._ <br /> Laserfische: ,I <br /> O <br /> a <br />