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LAND USE PERMIT APPLICATION-Burnett County, WI g:. 0 r <br /> 0 <br /> Applicant Complete All Sections Below This Line 5' E <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 \ <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 <br /> $150 CY n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° ?j <br /> Filling/Grading $150 Boathouse $500 r• • <br /> Six Month Cam One Per Year ° <br /> in <br /> p g Unit( ) $100 Permit Extension(1 Year Extension Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. Cip <br /> 2, <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be tre 4ed as accessory structures,such as:pergolas,landscaping,etc. ro , <br /> Property Owner's Name: tibt_t.' AC./ Cw <br /> t It , ( l.jQ .- z , <br /> P <br /> Property Owner's Mailing Address: 3 2(o4 �; -s,._e, O, u()0 d!)w V'I-IV b <br /> City Stie I Zip <br /> Property Site Address:+ <br /> 0 • -4---. . IP q,,,� _ y �. _Or <br /> Contact's Telephone Number: r <br /> �70 c)—ti—7 gi 9 o <br /> E. <br /> Contact's Email: V A-I 11(LO 11 , ( .C.30 x.v,... =7 d <br /> Legal Description of Property: ` N <br /> N b <br /> Section#: Town#: 40 N Range#: I,7 W Town of: I&l 0 v'.-- w <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> G <br /> h <br /> Tax ID#(1-5 digit number;found on tax statement): 00% <br /> 3. <br /> Proposed Use of Structure/Addition: 4-0 rz-e� �' <br /> Anticipated Start Date: �,...,. I, —O -i (H a/Cabin;Commercial Business;Bedroom;Deck;etc.) c x <br /> BuildingContractor: O j ` d <br /> S � Sewer Installer: <br /> AREA BELOW THIS LIN OR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7 <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 O <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z lot <br /> home additions,and bunkhouses.** ;v <br /> (rle6-- a 56-bac-kb '. Mu 4-- be- W 44. off 5i14e l.?-t-ifne <br /> Fee Rec: L 5L) <br /> Cg <br /> 4 Check#: /59 <br /> 1 /I? r, <br /> Date of staff site visit: Initials o ite visit sty =Si 1l a <br /> /semr : ..C�- <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: q/1 ?/2 < co <br /> UPON APPROVAL: APPLICA MUST POST COPY OF '-', WE:, m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? a a <br /> Transcendent: - Page 1 of 4 A'' <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 3 <br /> i <br /> LL <br /> ro <br />