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LAND USE PERMIT APPLICATION — Burnett County, WI a b t~ <br /> Applicant Complete All Sections Below This Line =' - <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> CD <br /> ' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150N O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 c <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ?� <br /> Filling/Grading $150 Boathouse $500 (ppyVVV���, <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 <br /> w <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. a <br /> *Items not listed above will be mated as accessory structures,such as:pergolas,landscaping,etc. ro ii <br /> Property Owner's Name: - /�1 f / 7/4„? IA/ ° z <br /> Property Owner's Mailing Address: /4/4"/- 47f8 S7i.�,cx,:7— ''le--1-54,1 1-11`7 -05% o <br /> Pt <br /> , / City State Zip <br /> Property Site Address: / i / ����',�,��y� i4/.1-- . .--71�`G/' � � <br /> Contact's Telephone Number: • G 7 d !%/ ?c-.< <br /> Contact's Email: b141 194(40--e°1 /ei fi el/4 7kG� (-4J1.-(-4J1.-7.1, ( , <br /> d <br /> / r _ m <br /> Legal Description of Property: / �C�/`/ ./-. N y 6/' S-c_c_ `' <br /> Section#: 2 Town#: f`, N Range#:l 1/ W Town of: Jam(i' N <br /> °nv4 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement):,(, C/>�� 2 , <br /> Proposed Use of Structur Addition: c/" inc $ ii 'C e-/ . <br /> Anticipated Start Date: e C =5 o w <br /> p ,��p (Hon2e/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: � ,70/1 e_ Sewer Installer: ------- - d <br /> OJ H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I, <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to ..-Z <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z 4 l <br /> home additions,and bunkhouses.** Pol" <br /> ( �ee-k— a,(t 5 ac, i <br /> a N0�- r k..v a," kt4 b, ,-0 on <br /> z Fee Rec:C50w <br /> N Check#: .' /3 <br /> Z <br /> a <br /> Date of staff site visit: 11/30/02' Initials of s' e visit staff: = m <br /> APPROVED BY LAND SERVICES OFFICIAL: /a - . . -- — " DATE: `7.1' /?' <br /> if: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF -' . <br /> 7.: ER <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o N G' <br /> w Zr <br /> Transcendent: - Page 1 of 4 .4 <br /> iiiiil <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 , a <br /> ��J <br /> a <br />