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LAND USE PERMIT APPLICATION—Burnett County, WI & b <br /> Applicant Complete All Sections Below This Line y 0 NI <br /> Permit Types and Fees:(Please,check appropriate boxes) ,-.• o. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `' Q <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� 0 <br /> A Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 t- 0 ea <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CP <br /> I. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. iiV <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i 3 <br /> =° <br /> @. <br /> 0 <br /> Property Owner's Name: `> v e ^3 t h iv e (� J G z <br /> Property Owner's Mailing Address: 7 ' `1 i F e `-1 K*t S ir) lL �YO 5rq o 0 <br /> r rV � City State Zip b A r ' <br /> Property Site Address: - b to - l 4 j P J 1' V, <br /> Contact's Telephone Number: 716.- (7,Z tp 1373 1 , o y <br /> • fD c p <br /> Contact's Email: ;(_\f)tC 1 jYIGki I• �DrA <br /> d <br /> f k/ i " i - cr ,i Lit, u � , <br /> Legal Description of Property: --Cl I C,SM ' / -,/6/ 7 ( f fj(�'L ) .Fr r/ /7 C a- <br /> /� / N -0 <br /> Section#: (1 Town#: 3? N Range#: 16/ W Town of: /�9,y CG,,A'e . °° <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ov <br /> Tax ID#(1 S digit number;found on tax statement): <br /> /93 ,. <br /> I <br /> Proposed Use of Structure/Addition: .$ (-7j .7) <br /> o a <br /> Anticipated Start Date: 0/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) P E ' <br /> 7..t..\ d <br /> Building Contractor: 7( Sewer Installer: ( �I i� <br /> i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V� R. <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 front them prior to <br /> ANY construction taking place for any dwelling.,dwelling additions,manufactured homes,manufactured z <br /> ig <br /> ho additions,and bunkhouses.** � <br /> Thee alt 5 �� - -VVNI1'��� <br /> c hE,c kt)0 10, )icLi <br /> s Fee Rec: G —_ <br /> I,o ` q/ Check#: ���3 5 <br /> Date of staff site visit: Initials of ite visit staff: s. <br /> 51 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ID/X)/?/ <br /> M <br /> UPON APPROVAL: APPLICA�.1� UST POST COPY OF -3 ' I I <br /> SICNF11 PF.RMTT APPT .Tr.ATT(1N TN PT .ATN SICT-I T 0 <br /> Q C. (11l <br /> K <br /> Pio 1 of d ? CD CO <br /> <.m '� <br /> " Land Use Application—Rev 12/2020 - <br /> Laserfische: amu`��"` . .,.,,,`y' WIm [FE <br /> - oC <br /> WI <br /> r o <br /> js <br /> ,� <br /> 511 <br /> i/f ` )'0 4-e ir Lied a <br /> Q:= f <br />