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• LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line '6 c 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) e, <br /> d <br /> 'Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 g <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 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 /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .. <br /> Filling/Grading $150 Boathouse $500 r ' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o Iv <br /> cn <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. - rr <br /> Q L[�/ o 2 1' <br /> Property Owner's Name: it l t G��Y S A 1 cel �.1 S r o �` <br /> Property Owner's Mailing Address: /86' / 9 �/S �1�#. c� �Q 'r t'''S r L °o <br /> City State Zip $ <br /> Property Site Address: p? 1/2.1? Di r)oil- �.a Y' a c.) <br /> Contact's Telephone Number: ex5 e 5 1 b l ^ 5" 70 / `? • c <br /> Contact's Email: a ✓'S " _LS 2 cirY�al ( • G d <br /> s C V. z 3? -� <br /> Legal Description of Property: �4 � � ( /�/� <br /> / 2 oc <br /> Section#: Town#: 41) N Range#: I to W Town of: �(<L ci <br /> " <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system propertyPa e.* <br /> CI <br /> Tax ID#(1-5 digit number; found on tax statement): J'-LOt 3-5981 a. X Z-0^^,, R. <br /> Proposed Use of Structure/Addition: 5 r p GG Lt rt' c�- o1 e G K "' <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 'rte, W k <br /> Building Contractor: 5e 1-P Sewer Installer: Zb d <br /> 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: skQ <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> Q <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z oQ <br /> home additions,and bunkhouses.** L:1 <br /> 6 See_ VAR-Z1-2.1 r a p e'oria` of- Mtc._ sporf5 cour <br /> z:W'1^i 1 i's 'C oy e 5 f�a7'"S Go ur' 9'Yl��� <br /> o� � east s)'� � br�H�r�iOUJ <br /> z Fee Rec: <br /> y Check#: <br /> / v <br /> Date of staff site visit: /0/ l/ Zi I Initialsof site visit staff: � z <br /> v.APPROVED BY LAND SERVICES OFFICIAL: DATE: 2//it/2•49ZZ— m <br /> r <br /> U lit <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF a 03 <br /> mCO 0 <br /> <.S <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? N <br /> a0 = <br /> N <br /> Transcendent: Page 1 of 4 m m N <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 m 3 `ff <br /> a <br /> c4 ' ' <br />