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LAND USE PERMIT APPLICATION — Burnett County, WI .
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<br /> Applicant Complete All Sections Below This Line $
<br /> Permit Types and Fees:(Please,check appropriate boxes) O
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?: 4
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 J,-
<br /> /Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ';•-_ 0
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °
<br /> Filling/Grading $150 Boathouse $500 v
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100
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<br /> *NOTE:After-the-fact permits(permit squired 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. 0
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<br /> Property Owner's Name: / �p1,-- A,/e,x sLoze- o
<br /> Property Owner's Mailing Address: a[(p3 6/.S /24,11 c 5,,--i- , /0 v Slit x_40,-- �-�ol S
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<br /> Property Site Address:, 2--(0,-g 0 '� � �.,,,AL-- L. &? J,) !*./e',4s- kir .67f99:5 ° cn
<br /> Contact's Telephone Number: /c3--3-a/-4`Y/
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<br /> Contact's Email: j..p Y3'�c G.,,,i..yl _ o
<br /> Legal Description of Property: p7, G?9'-.2 ''-fc-„› /-7/-/6 -y 13 -4a#
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<br /> Section#: 1"./.4. Town#:�yN Range#: /r/y W Town of: s.ffr
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<br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.*
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<br /> Tax ID#(1-5 digit number;found on tax statement): Z,p-`p 32.
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<br /> Proposed Us:�/Addition: C�iR� Pi --3 H
<br /> Anticipated Sta a a e: �--a ea r?a (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) o
<br /> Building Contractor: _ es,,,k,it,,, ta,,) Sewer Installer:
<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 O
<br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z
<br /> home additions,and bunkhouses.** I�
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<br /> Fee Rec:
<br /> Check#: a095
<br /> Date of staff site visit: 1i 12'/2? Initials of ite)t st-7 z
<br /> APPROVED BY LAND SERVICES OFFICIAL: r/ DATE: 1 0030--6-
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<br /> PON APPROVAL: APPLICANT' UST POST COPY OF v) a
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<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0'11 i
<br /> Transcendent: Page 1 of 4 e
<br /> Burnett County, WI Land Use Application-Rev 12/2020 P.: r
<br /> Laserfische: u at
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