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LAND USE PERMIT APPLICATION— Burnett County, WI cr <br /> Applicant Complete All Sections Below This Line <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?Y <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `--..„ <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> GQ� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 U Ft <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <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. - ^ 1 <br /> CD <br /> Property Owner's Name: (5 itAlt_, 3 h1c'\-1 Q_ o <br /> Property Owner's MailingAddress: � ADX a t° 1 :�eri�� h1� S � 3c, <br /> . <br /> City State Zip •o <br /> Property Site Address: 1`i S 1bn�,4 IC K k_ .Rcc 130.7,e_(' _. <br /> Contact's Telephone Number: (5t ) s .b---/a9 I o <br /> cp <br /> a. <br /> Contact's Email: 41i tlanM-Ar(ic i 611(�f hPi- /1Q1 i ,�{1/1 d <br /> 5hve ®•1-11cr✓%cma:�• CD/t-7-' <br /> Legal Description of Property: <br /> �^ _ l 0 00 <br /> Section#: 14 Town#: N Range#: 14- W Town of: at`'+}^ <br /> go <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPaSe.* <br /> P. <br /> Tax ID#(1-5 digit number; found on tax statement): l(%0OS a' <br /> Proposed Use of Structure/Addition: (,l)t��'kSAop � c y cu "' Io <br /> Anticipated Start Date: S ft (Home/Cabin;Co ercial Business;Bedroom;Deck;etc.) <br /> ff� ll <br /> Building Contractor: 5�'1A.Lo T. CO fU(( C , el;ENS ewer Installer: n <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Cl <br /> G <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 dwellin s,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** <br /> 001 ee,k a,1( 5 s <br /> Aio - x' hums() kb1- <br /> • ( ;4çç> (- a,/'1'IQ/A -��,p �'1'`_ 4 Check#. JO l <br /> o <br /> tri <br /> Date of staff site visit: 11 i L 6 / 2-1 Initial of to visit staff: ,of /---___ t- <br /> CD <br /> II q / <br /> APPROVED BY LAND SERVICES OFFICIAL: /�� DATE: /i 1- <br /> UPON APPROVAL: APPLICA .i�� UST POST COPY OF c o' <br /> iz — 7' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .:=? (=> _i <br /> Transcendent: - Page 1 of 4 3 <br /> Laserfische: - <br /> Burnett County, WI Land Use Application—Rev 12/2020 m: <br />