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LAND USE PERMIT APPLICATION—Burnett County,WI a 1 b <br /> Applicant Complete All Sections Below This Line 5r <br /> Permit Types and Fees:(Please,died(appropriate boxes) o. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ' d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ... ---Vs <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '\ I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Rj <br /> Driveways/&Campground Structures $125 Wi State Statute 59.692(1v)Structures $350 < p Ili <br /> Filling/Grading $150 Boathouse $500 r- <br /> o <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. <br /> 'Communication Towers&Signs require a different application form;see corresponding application,and fees. 7 <br /> 'Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc a tp <br /> r g <br /> Property Owner's Name: f( U k 5 ht�1 € > 0 1i <br /> Property Owner's Mailing Address: I C `.j C) j4-t�1-cl i i4l Ru E i¢( k., ,s,, ih�i 53-00 4 o r City State Zip $ <br /> Property Site Address: 3 Q e(,�Cb til a_ (;) �j${tet{ (�l• .7. <br /> 3 <br /> Contact's Telephone Number: 4::,5-i - 353- 7,2qa, . ... 2_ r. <br /> �A 1 _0. <br /> Contact's Email: .p5 r,t r-te 5 e J m ct tiNc , t Cairn d <br /> i. <br /> Legal Description of Property: 5 Yr_ s E 1.)E <br /> IN1 'V <br /> Section#: 7 Town#:3 8 N Range#: /5- W Town of: LAT°//e i-+€ 004 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> O <br /> m <br /> Tax ID#(1-5 digit number,found on tax statement): ! 578 SI <br /> Proposed Use of Structure/Addition: 1) Li t/(i N y w <br /> Anticipated Start Date: 51Z2.1 2 2 (Home/Cabin:Commercial Btu:Bedroom;Deck etc) f <br /> Building Contractor: #/Q Sewer Installer: £,J,44t <br /> -I <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,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** <br /> aprint4.- 5 .� 0q 1 <br /> i �'►l.• ercz eei 2 becLah,i''"5Pe( 7 0 <br /> E' Fee Rec: "1/O0 <br /> T. Check#: I/O ) <br /> 01 <br /> Date of staff site visit: 1 l I(1-/9-' Initials of site visit ff: I ,iggi <br /> z JEl <br /> 1(fal�( cA <br /> o <br /> m fl) <br /> BY LAND SERVICES OFFICIAL: / DATE: < <br /> c <br /> ¢mi 0 CO C7 Q <br /> UPON APPROVAL: APPLIC A ST POST COPY OF a U -1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 3 <br /> Transcendent: - Page 1 of 4 A 3 Hil <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 <br /> c <br /> m <br /> �J <br />