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• <br /> t. <br /> LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> i <br /> Applicant Complete All Sections Below This Line cPermit Types and Fees:(Please,check appropriate boxes) a _' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 dVCommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 WX Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 PAccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 \ 114 <br /> Filling/Grading $150 Boathouse $500rSix Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 i <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. c*Communication Towers&Signs require a different application form;see corresponding application,and fees. q*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -o <br /> Property Owner's Name: jcyh it( G('q A rv.. o 7491 (� ,L p z <br /> Property Owner's Mailing Address: p?l, (c CAt z AU iL SI ' 41 � 6 0IP <br /> A, it State Zip % w <br /> Property Site Address: /Uv1te-- )L0,?) 054-e( rcNi =. ; <br /> 2 . 1 <br /> Contact's Telephone Number: (C.5/ / 7 � 7o <br /> Contact's Email: d <br /> � <br /> Legal Description of Property: T f CCM 142-Wig-F".? c <br /> o a <br /> Section#: 3 Town#: 3I N Range#: f'7 W Town of: 4-j h (E)w <br /> *Attach additional page if needed for lengthy description OR attach a copy of thethdeed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement):) ch/5g/o i~,• <br /> Proposed Use of Structure/Addition: hedc0 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) :-. <br /> Building Contractor: Sewer Installer: <br /> o <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 1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** Pc, P <br /> 0 Ole Se444 <br /> S <br /> 0 Nc*- ( L,A44ci. 0 114 liDd <br /> 2 Fee Rec: /✓V ef- <br /> Check#: GSA <br /> o <br /> ri <br /> Date of staff site visit: 0711 Initials f site isit s ,:;•,..e, r <br /> APPROVED BY LAND SERVICES OFFICIAL: ./7:::-...-A/ <br /> DATE: IsW1 3' PI i <br /> UPON APPROVAL: APPLIC 0T MUST POST COPY OF L `-� <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT eq �- ?o <br /> Transcendent: - Page 1 of 4 2 N <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 al <br /> =m <br /> 0 HI <br /> D <br /> b <br />