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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> . b <br /> Applicant Complete All Sections Below This Line El' <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r--"� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '#Q 0 <br /> Accessory Structure(Commercial/Industrial)_$200 Addition/Alteration to Bunkhouse $150CD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 N <br /> 7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 4 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c4 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. i <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. CD , <br /> r <br /> Property Owner's Name: 6 purtiPcleT3eg, z <br /> ,. <br /> Property Owner's Mailing Address:6i 30 1- Ole-(AT-it 1/{' O i ff 1---b ine, tj&f s ,t 9 $ k` <br /> d ( City % State Zip a r <br /> Property Site Address: 3 ��tOI U`� €b> c \ <br /> `7 `a - `i (, < s fry < ' <br /> Contact's Telephone Number: �CLc � 'L e�r �� <br /> Contact's Email: C{✓`Ai 7 P Se i wi tied et t.�G 11 ttt°Gtr 6- 1• o <br /> Legal Description of Property: 1/OT -S ' cSA)L 4-i d . kik?) 1 St9 A CDSection#: 3 c Town#: 4 () N Range#: f > W Town of: ,, il{'C� d' <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPage.* <br /> Tax ID#(1-5 digit number; found on tax statement): l�� <br /> Proposed Use of Structure/Addition: Nit La_ 4-1--,9"e__ x:). - '-l''''' <br /> Anticipated Start Date: Cr t '2. e 2.. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> _ F _ <br /> V\ <br /> Building Contractor:M J1�1/� Vl t`''��iU� Sewer Installer: PLA—S <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 then:prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z d <br /> home additions,and bunkhouses.** z <br /> O�elll'r j �.o-4- iv enceeS 3 b t(i ' petBiu ?I- ?-9S <br /> 81 <br /> 8 I'Ylee-- axT<< dJ(-s (NA- +0 encee 1,6 � <br /> 44 Mi.k to-4 5;de 0 <br /> :-' Fee Rec:. ......p <br /> '4 Check#:O(3 , <br /> � /?. <br /> fDate of staff site visit:!1 fL.9 l Initials of ite visit staff. JI r , <br /> APPROVED BY LAND SERVICES OFFICIAL: / %, 7 DATE: 10 I/0- 1 X11' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF v (0� <br /> r. UvU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ar C oCI <br /> Transcendent: - Page 1 of 4 �` n14 <br /> .1 <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 <br /> y <br />