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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> Applicant Complete All Sections Below This Line c <br /> Permit es and Fees:(Please,check appropriate boxes) n' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w ...1 <br /> ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `.. <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150rp <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 V <br /> Driveways/&Campground Structures 0 <br /> y pg $125 WI State Statute 59.692(Sv)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> En <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> E. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> ,& te <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> r . <br /> Property Owner's Name: & (V J t-.e li1( r ° o <br /> Property Owner's Mailing Address: p5,ltd I e (\, LI, 6-4'l),V�' Ove( , IAJ :- �J-----15/ 61. a <br /> G Q Citi State Zip <br /> Property Site Address: 2) oqS , k f,c . cs'1n„Z Ak5b ,cY lrt � Le czi n W <br /> + 22 J � <br /> Contact's Telephone Number: 1 1� ")1 C9?)2). o v <br /> 24....... <br /> 1 • 0 1. <br /> Contact's Email: 'i'V1elr�` i(; tbiN, �v. <br /> u <br /> w <br /> Legal Description of Property: <br /> b <br /> Section#: 33 Town#: 3`A N Range#: (4 1 W Town of: W r 2," .4YI N <br /> ,, 00 <br /> ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> m. <br /> Tax ID#(1-5 digit number; found on tax statement): 3 15 5q9 <br /> .„. <br /> Proposed Use of Structure/ it' 11D I'1/1{ 7c4 <br /> Anticipated Start Date: 1�/I�j( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o X <br /> 111 !!!! _I'ak vJL <br /> BuildingContractor: I�G�^� OL.� �A{.V Sewer Installer: i SS }��L� a <br /> y <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 --t <br /> home additions,and bunkhouses.** Pzi <br /> $D,A,%1,-FJS / �oo�t5 �� 5N-�I t7 <br /> ( , AA Gee�tJ , / <br /> Fee Rec:3(...X)'' <br /> FS Check#:- 5Q. <br /> o <br /> rn <br /> Date of staff site visit:'0 0 f ( Initials of si visit staff: r <br /> / / - �� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: eIO1�n ;./ • m <br /> UPON APPROVAL: APPLICA ✓ "MUST POST COPY OF . o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r CO0 CD <br /> 0 N <br /> v7 p <br /> Transcendent: - Page 1 of 4 n 3 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < %rri <br /> ' ' 11111 <br /> cna <br /> 3 <br /> -o <br />