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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 3 <br /> Permit Types and Fees:(Please,check appropriate boxes) 4;7. GC <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e OC) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `" 16— <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 p <br /> Filling/Grading $150 Boathouse $500 r ((� '�\ <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. 2 ---1 <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. �v <br /> Property Owner's Name: 9P 1D P C I.-\K\ l 6 \1 S E N a <br /> z ct <br /> Property Owner's Mailing Address: 94, e62..._ L I ( ' 8, ale 614401 - <br /> Cityt,� p� <br /> Property Site Address: 5_>C-s.•-5_>C-s5_>C-s.•—e_ `{' <br /> � — = n <br /> 3 <br /> Contact's Telephone Number: 6 �l . 2 4 Sc D5 o• 7 P <br /> Contact's Email: o <br /> Legal Description of Property:La t 1 C 501 VI ? p 25& ( 34 94.13-3 $r J /011-) <br /> N crc <br /> Section#: Town#: N Range#: W Town of: <br /> E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number; found on tax statement): / D 9 6 7 <br /> Proposed Use of Structure/Addition: Cr,0-4"ea se . ch <br /> J- � -� -� <br /> Anticipated Start Date: /0 " ( ome/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> ��e c <br /> Building Contractor: S Sewer Installer: .__. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMIENTS/CONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'k-ZI <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to CT\ <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** z <br /> Yice'4- all <br /> rIPS <br /> a �o - <br /> - , 16 ske.3 i ,,,,.sa 5 Pelf ;c- <br /> Ke 3 e- bw�! orb 1?-lel?1 ,� <br /> J7. _ Fee Rec:#lsD� <br /> P 1 Check#: .558-1 <br /> Date of staff site visit: t°/17/2-.' Initials of site visit staff: /v <br /> 4 / , <br /> APPROVED BY LAND SERVICES OFFICIAL:_ i� /_;.----;---- DATE: 1007/2/ < <br /> // m <br /> UPON APPROVAL: APPLIC 4. MUST POST COPY OF w w c , <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT y <br /> tF8N <br /> Transcendent: - Page 1 of 4 7 w 'a o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 2 3 <br /> -3 = <br />