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LAND USE PERMIT APPLICATION - Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line 3' c <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> CD <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> CD <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 0 <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 /> 9. <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(1Year 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: r <br /> ev/A4 4. C'/e/+/(/e/,s o z <br /> Property Owner's Mailing Address: 2/521 RietuLNcr )r(/rc joicbm t 1J 55352. g <br /> �/� City State Zip $ <br /> Tff <br /> Property Site Address: 27553 o/�/ocai J Rot/ /Citi (.JEt3ST/A ' <br /> E <br /> Contact's Telephone Number: 95Z — ZI Z -/*038S o N <br /> • c <br /> o <br /> Contact's Email: 8itc, 7'/i F40 ansa/L, ,, C 2fr e <br /> r <br /> Legal Description of Property: BU 4Jf.TT CO. aim-i Fl t4 Suave?? MA* No 477 <br /> Section#: 36 Town#: 40 N Range#: /5 W Town of: a4Cks Ej Af o °G <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): 34893 <br /> Proposed Use of Structure/Addition: VAC/r7/lit/ P Mg cr <br /> Anticipated Start Date: 04/ab Z Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> , <br /> Building Contractor: Sewer Installer: /109440/41511.le `j <br /> d <br /> -1 <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 <br /> ANY construction taking place for any dwellings, dwelling additions,myI a, ured homes,manufactured z <br /> home additions, and bunkhouses.** / // <br /> I - I / / 9 / 7/).0,9./ _, <br /> ,. liSmEct, , <br /> Fee Rec• <br /> N Check#:.241 Li <br /> 0 <br /> m <br /> Date of staff site visit: Initials of site visit staff: G , <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: -• ( A <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <3 Gs <br /> :• m 1OW <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' o g CO <br /> 0 C IN <br /> Transcendent: - Page 1 of 4 ; ='` <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 huh <br />