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LAND USE PERMIT APPLICATION — Burnett County, WI c r <br /> _ <br /> Applicant Complete All Sections Below This Line c i—k <br /> CD i <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> ,,..-- - , $ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `., <br /> Accessory Structure( arag,Shed,etc.) (150 Addition/Alteration to Accessory Structure $150 °Q O <br /> g <br /> Accessory Structure(Commercial/Industrial) 00 Addition/Alteration to Bunkhouse $150 2'' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> t-..Drivewa s/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r° <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r 0 <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. ro 111 <br /> Property Owner's Name: /*I /v L °Apr) J. g <br /> o <br /> Property Owner's Mailing Address: 6.876 ..-„1(i i h F') /24 t.,Jc rc( t tj l f � Er <br /> 0 <br /> City State Zip $ C-- <br /> Property Site Address: gaD7 teei 5• <br /> Contact's Telephone Number: 715-- b. t76 �• c 7 7 o <br /> Contact's Email: /I disl 0 ), Yi V 11 t r itiviGl.f . Coin : <br /> co <br /> Legal Description of Property:-east--:'ka ;- - - ---C/�7uC 4n cf <br /> N <br /> Section#: -<1 Town# : yC� N Range#: I(0 W Town of: O t a ac <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): 35%3 <br /> Proposed Use of Structure/Addition: 84,-rct-ye <br /> Anticipated Start Date: wl/ ,3 o .( V `� f <br /> x,�,(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �� x <br /> Building Contractor: - /P J mall Sewer Installer: <br /> ti <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <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 M <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additins,and bunkhouses.** <br /> Clee+ oil( se-&b�, - <br /> ok- -6( h.44444 vta r -;e) /1 <br /> z Fee Rec:_ b <br /> Check#:3/11/7 <br /> Date of staff site visit: to/ 7/c?'( Initials of.ite vis' staff: I <br /> ‘ .,..:„. .CC= <br /> APPROVED BY LAND SERVICES OFFICIAL: fa_i . /%// DATE: lagf p� fig E <br /> UPON APPROVAL: APPLICANT' MUST POST COPY OF '``> q <br /> — - a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 'W t <br /> ►0 ►— ;f <br /> cs <br /> Transcendent: - Page 1 of 4 ;, O <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 ' 5 <br /> a <br /> b <br />