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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> . a b <br /> Applicant Complete All Sections Below This Line °' <br /> CD i <br /> Permit Types and Fees:(Please,check appropriate boxes) o. <br /> d C" <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 : <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure _$200 <br /> 2C Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Q.) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 (T( <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 'j j <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 --- G <br /> cn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. Co W <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. - <br /> Property Owner's Name: 5 0 hi Ai d-,f Ce L. 1 E L.COjt c f 3/'-, 1,-`°"' i274 ° z <br /> Property Owner's Mailing Address: 36 419 4,&,4 Lo,t� ezaze_,-7- //./A) o":50/ o T <br /> 2 ® � ! f�-,,� City State Zip o <br /> Property Site Address: e©�✓ /�C� [yC 5f -� <br /> Contact's Telephone Number: 17— 0 5i-- 77/0? I/ o 7 <br /> Contact's Email:'i%f vi,Z 084-4-7 ( a ,./1..p I./ d#2--)"~ d <br /> p ' <br /> Legal Description of Property: • ., \ <br /> 1o ac <br /> Section#: Town#: N Range#: W Town of: •-.5e-017"-" 0 <br /> 5• <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 /> Tax ID#(1-5 digit number; found on tax statement): T' <br /> Proposed Use of Structure/Addition: Ja��L. [4 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom; eck;etc.) -i c. x <br /> Building Contractor: Sewer Installer: g �`1:'� <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 <br /> home additions,and bunkhouses.** <br /> Din e+- eh 11 5 eThct Cit <br /> e0lop� - - h ,t�h Gt4b,= , <br /> ho Id. ,i rvi`ev s C42 ,T yA.. h y► <br /> x Fee Rec: <br /> Check#: o'�//0 <br /> Date of staff site visit: 10/111/? Initials site visit staff '— II <br /> v <br /> cm <br /> � <br /> � J <br /> Q <br /> APPROVED BY LAND SERVICES OFFICI �TE: 1016A5l I • m <br /> UPON APPROVAL: APPLIC A .. - " UST POST COPY OF i 0 <br /> CA SIGNED PERMIT APPLICATION IN PLAIN SIGHT "°• 0 Eitil <br /> Transcendent: - Page 1 of 4 <br /> Q <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 <br /> - 1== <br /> a <br /> v <br />