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LAND USE PERMIT APPLICATION — Burnett County, WI r
<br /> Applicant Complete All Sections Below This Line 6' � �
<br /> Permit Types and Fees:(Please,check appropriate boxes) a.
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 G
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .4
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O 0
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 V
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° U ,ge
<br /> Filling/Grading $150 Boathouse $500 -r- v LkA
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100
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<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees.
<br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.
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<br /> Property Owner's Name: -1-42,1 U, L. -I- I Qre3 c j . Ped. .5 0 0 E—
<br /> Property Owner's Mailing Address: of:). 1 (' re5 W l 3 4OoL$ g
<br /> �� City State Zip c.
<br /> Property Site Address:91-19 N ,5 10,110,1_12 Q �"X.�.kr�� v y Lo l 54-tg3 b E'
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<br /> Contact's Telephone Number: 1 13 -4 y A - C' 5
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<br /> Contact's Email: 4}A-ri\v,.,C C -}ury I t 4A, . t d
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<br /> Legal Description of Property: ..
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<br /> Section#: 1 Li Town#: 1 I ) N Range#: 1-1 W Town of: 1,k.-vv.(o r\ 7 °G
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<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*
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<br /> Tax ID#(1-5 digit number;found on tax statement): c�y' /oZ g F,'
<br /> Proposed Use of Structure/Addition: (lor\( X - bo.,c
<br /> 1 Dr�9 C1:15):'
<br /> Anticipated Start Date: (Home/ abin;Commer ial Business;Bedroom;Deck;etc.) o k
<br /> Building Contractor: Sewer Installer:
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<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 3
<br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z
<br /> home additions,and bunkhouses.** z)
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<br /> s Fee Rec: 156
<br /> c Check#: /o1a75
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<br /> Date of staff site visit: 1 D L 1 Q I? I Initials site visit staff: ,1 (// z
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<br /> APPROVED BY LAND SERVICES OFFICIAL: • , /%�� DATE: p�D[ j < ��
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<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a $ „ o
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° a —
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<br /> Transcendent: - Page 1 of 4 mo
<br /> Laserfische: -
<br /> Burnett County, WI Land Use Application—Rev 12/2020 < m
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