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LAND USE PERMIT APPLICATION — Burnett County, WI g g b
<br /> Applicant Complete All Sections Below This Line 0 n
<br /> Permit Types and Fees:(Please,check appropriate boxes) a.
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d
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<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 d 9
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 IL tt
<br /> x Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 U\
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 ° o
<br /> Filling/Grading $150 Boathouse $500 r
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<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. P
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,5
<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:Ryan and Jessica Tollander o
<br /> Property Owner's Mailing Address: 28520 Kilakre Rd Danbury (Northland Builders Inc) o 7)
<br /> City State Zip .a
<br /> Property Site Address:_ 23047 Old 35 Siren WI 54872 e
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<br /> 715-259-3257 Northland Builders Inc <
<br /> Contact's Telephone Number: —__ g
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<br /> Contact's Email:northland001@centurytel.net 4
<br /> Legal Description of Property: I'. (----
<br /> Lot 1 CSM V14 P 149
<br /> 28 38 17 Siren i; b nr
<br /> Section# Town II N Range#: W Town of: _.
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<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach Ica system property page.* t7
<br /> Tax ID#(1-5 digit number; found on tax statement):2647 9-
<br /> Deck extension �� 1 �,�_�A
<br /> Proposed Use of Structure/Addition: t � � ��i7MOt1� �Fj a� 8 H -3
<br /> Anticipated Start Date:October (Nome/Cabin;Commercial Business;Bedroom:Deck;etc.) 5 10
<br /> Northland Builders inc NA d
<br /> Building Contractor: Sewer Installer:
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY p):.
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: T..'
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<br /> y�blkr Y(' / / z Fee Rec��
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<br /> Check#:3_12520
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<br /> Date of staff site visit: L(//I q I?I Initials ofite visit teff g r
<br /> APPROVED BY LAND SERVICES OFFICIAL: �' � -,..////� DATE: 2/
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<br /> UPON APPROVAL: APPLICA ,��UST POST COPY OF r
<br /> SIGNED PERMIT APPLIC • TION IN PLAIN SIGHT ° gni0
<br /> Transcendent Page 1 of 4 into (�
<br /> Burnett County, WI Land Use Application —Rev 12/2020 0
<br /> Laserfische: CG 1‘.3
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