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.Y, <br /> b <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line C c Nr <br /> Permit Types and Fees:(Please,check appropriate boxes) CD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d 4 <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 (O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> x Filling/Grading $150 Boathouse $500 r. <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> lb <br /> *NOTE:After-the-factpermits q begun)mayup : <br /> (permit aqui after construction has be un cost to three times the normal fee. = ' <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. F <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> • , r" 0 <br /> Property Owner's Name: '--Z�/1;4 G- -0 L L . ( , L-1---/_=L ° .z 1 <br /> o <br /> Property Owner's Mailing Address: �rj-c3 T'7 CZC'. i'- _7(31, /z-) • o <br /> (11 <br /> City State Zip <br /> Property Site Address: //?i: F. n <br /> Contact's Telephone Number: —7/S-- .,6 - .) (' SN <br /> •o <br /> O <br /> a <br /> Contact's Email: d <br /> Legal Description of Property: IR-- 1.3 ' I.2 1_1,2_ t\pt. Q A J Z. L-ci— <br /> o <br /> N c <br /> Section#: I Town#: N Range#: I L. W Town of: i1'� -a w.�-� °` <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> b <br /> Tax ID#(1-5 digit number;found on tax statement): (i CI()d 9. <br /> Proposed Use of Structure/Addition: Get (- /,I F4z----- /'i c' <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor:NO �Kt p1S- �7?/C tt -- --Sewer-Install -: (/7-)6 2 & d <br /> t --� 7�� 7 r�-- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to p <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> 4 me additions,and bunkhouses.** <br /> S,•% � 4 6a /K f74//e-1 CiH 1 114a"14744°M4 <br /> tIN <br /> uK 47 Vep 4o. i$ es/c-.4%.kie_a! <br /> No u t, - 4//ocvec/i%1 7"4e_ rd rriAof1 way, rw 07 <br /> Fee Rec: L , <br /> r4 Check#: BOG. <br /> 6 <br /> m <br /> Date of staff site visit: Initials of site visit staff: z <br /> o , <br /> APPROVED BY LAND SERVICES OFFICIAL74::: :::) <br /> : �� -.ATE: I�/ZO Z/ ._ [-� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �:: z `--hull <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT de 3 <br /> o lfiffl <br /> Transcendent: - Page 1 of 4 II 8 <br /> Laserfische: - <br /> �' <br /> Burnett County, WI Land Use Application—Rev 12/2020 Q <br /> Rill <br /> 3 L ` J <br />