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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 k''' ...A <br /> • 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <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. p �c <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. r--- <br /> Property Owner's Name: 5(✓IC.A.R�.t V LI— 0 z �^ <br /> P <br /> R 1_ o J , <br /> Property Owner's Mailing Address: ` 0 (3 'J4 3? 5- t" e 17S 7�''`� �� 5r—t Y93 o <br /> City State Zip <br /> Property Site Address: )-q 2-1 fin-1e6\ tat C.I4j cl 0�nb,,,,(-7 ,v i s---,4 le)t.., <br /> Contact's Telephone Number: 71 S - j 6 6 U S 6 I o <br /> Contact's Email: 56_1* 4@ 1,��e < t.U ^.ro <br /> w <br /> o <br /> Legal Description of Property: ok4 a <br /> N `c7 <br /> Section#: Town#: N Range#: W Town of: _. °° <br /> 5 <br /> v° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number; found on tax statement): 3 5 'i) <br /> Proposed Use of Structure/Addition: ri.k /Sir,. <br /> Anticipated Start Date: ii De _ ' .1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) P.- . <br /> F wk <br /> Building Contractor: 51`finL ' (--k (3H�,Id;^5s Sewer Installer: IfvQA, 5 <br /> -� <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 p 1 <br /> ANF construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z !__ ..z_ <br /> home additions,and bunkhouses.** x' <br /> i ►�Pe4 j sett S <br /> t4 LVP- 0 �3gZi aj <br /> a (neem ca.(' con ;hv 5 0�' _ . p <br /> z r- Fee Rec: 'nc3� <br /> Check#: (p7/ <br /> Date of staff site visit: t0 171a1 Initials of ite visit staff: L " z <br /> —/ , . <br /> APPROVED BY LAND SERVICES OFFICIAL: V. - . /- DATE: loll 2l a I �-�=J <br /> UPON APPROVAL: APPLIC • -'' MUST POST COPY OF 'a <br /> co co <br /> CD c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTy GO <br /> Transcendent: Page 1 of 4 -v � o <br /> co <br /> Laserfische: li <br /> Burnett County, WI Land Use Application—Rev 12/2020 a <br /> L J <br />