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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o' c <br /> pP P o CD <br /> Permit Types and Fees:(Please,check appropriate boxes) ' a. <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> :=C° „k <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 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading _$150 �oBoathouse $500 N 4 <br /> Six Month Camping Unit(One Per Year) $100 X 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. 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. tle.*1 rbc..( Peel,''1- <br /> L1P-2O- 0 o <br /> Property Owner's Name: �t j )C l'} )) /g3) V" o ; <br /> Property Owner's Mailing Address: 3 L. L) L e42 KS J . 1;0c S ,` i,u i $ <br /> City State Zip a. <br /> Property Site Address: _5,-'t v 5' <br /> kp <br /> Contact's Telephone Number: (, S ) _ S^0 ` ) i 7 Z o <br /> n <br /> Contact's Email: I Y",-47 <br /> c ( )i i C' v,-, 6) 6_ %7't i I `' iA, ` C7 <br /> w <br /> Legal Description of Property: c'f-- / C 5117 L / , fc,/ /5-3 <br /> N <br /> vc <br /> Section#: 7 S Town#: 7 La N Range#: / W Town of: 3--1( (--_/c j c)t- =. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number; found on tax statement): (:: () / 3 <br /> Proposed Use of Structure/Addition: <br /> f <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: Sewer Installer: <br /> ti <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'F <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 bunkh uses.** S Q/� L V f ?c)- )I ^UPzJ <br /> cpfv1ee-- all coy 1 fic `tio <br /> Fee Rec: 100" <br /> 04• <br /> o Check#:5332 <br /> cli <br /> Date of staff site visit:.4` / 1 Li /ill-I Initials of e visit staff: 1 !l-' z <br /> o 'rn <br /> rli <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: < g <br /> UPON APPROVAL: APPLICANT'' UST POST COPY OF > m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> .11 <br /> a g <br /> o <br /> A C Is., <br /> Transcendent: - Page 1 of 4 m Ia� ma C <br /> Burnett County, WI Land Use Application—Rev 12/2020 < a G <br /> Laserfische: tz <br /> C7 <br /> cna <br /> i <br /> b <br />