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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> 0. <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 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> o'X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 � p <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 f ; <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r ,..' <br /> o Il <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cA <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. <br /> Property Owner's Name: ,/W4)i 2. y ,ii�c h_ro.* ° z p <br /> o <br /> Property Owner's Mailing Address: 96 33 L4/ 'r x; 4 /y..f,'. 1 ,L,Al�5755 0 <br /> /� a. <br /> City State Zip <br /> Property Site Address: �9j77 C"p 2;' 22Qyl�jz.z.y y �'Sc gam® 7 <br /> 7. <br /> 6-3 / <br /> Contact's Telephone Number: `�,,�� ����� o <br /> o <br /> Contact's Email:)4'14).- 2.7,5Gli4li1r.), r oij�ri. /2 ) y S <br /> d <br /> Legal Description of Property: LaA.&x 1-C/~-4 4Z /pZ <br /> Town#: ° <br /> Section#: aq <br /> N Range#: /� W Town of: �GG ". <br /> aq <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): l 9:ff �' <br /> Proposed Use of Structure/Addition: . .--)--,4. <br /> Anticipated Start Date: (Home7Cabin;Commercial Business;Bedroom;Deck;etc.) SO <br /> Building Contractor: Sewer Installer: W 0 <br /> -, CJS <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYrat <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> i. <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 /> NA-- r6 r h,A wt, AkbcI- ,+"c ' <br /> 14'1-e€-4- ail 5C f <br /> i Fee Rec: ,1,5 v <br /> 7 Check#: G /CL6l <br /> o <br /> tm <br /> Date of staff site visit: II 1301 1 Initials o site visit stat / a <br /> ./ / ii <br /> CD . <br /> APPROVED BY LAND SERVICES OFFICIAL: a r I/ /, DATE: I O III di ,e-r, <br /> UPON APPROVAL: APPLICANT-MUST POST COPY OF ; c <br /> 51 u <br /> ila <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 ®' <br /> 3 <br /> Transcendent: - Page 1 of 4 c 1.2 <br /> limi <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 'M' <br /> f <br /> b <br />