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LAND USE PERMIT APPLICATION-Burnett County, WI a b <br /> N <br /> Applicant Complete All Sections Below This Line <br /> co <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m <br /> CD <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 <br /> /( Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° \ <br /> Filling/Grading $150 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 VI <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. - k <br /> > h H. r_ <br /> Property Owner's Name: ��/{�/ ljt�� fry/ l�� o <br /> Property Owner's Mailing Address: PO X (.o/4 (/V/ 5 '3 o <br /> �ac `fry- ��3/l> S 1y State3 ) vvv <br /> it <br /> Property Site Address: none- QGj „ n <br /> Contact's Telephone Number: -7/5'377-.25567 °<—`� <br /> Contact's Email: /6Z-0, <br /> ,, �,e�,�/-o n4'/�(�,h7[Co cOVJ/lq d <br /> Legal Description of Property: !�-�',� �M t / C / 43, 7/ <br /> 0 0 <br /> Section#: Town#: 3? N Range#: /CC) W Town of: /1 fee_*16n 0 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): 3172- <br /> Proposed Use of Structure/Addition: Si-oraq, un/:-/-5 (Confa ✓ i,rip I I ^ cn . <br /> Anticipated Start Date: ex,S`f/Vl�l ✓(Home/Cabin;Commercial Business;Bedroom; eck;etc.) J I , ¶N <br /> E3Building Contractor: Sewer Installer: N ji4 ( ` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY _1 \N,, <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z O <br /> /home additions,and bunkhouses.** a WWW <br /> 0 rti fs /p c ress X71- i e S ICP" fr 2& Cciryo co/4XV'7 e/r_C <br /> C!S SGO W d► Ili') GU P— 21 -/R ei e'-1.,,a/'fr. <br /> 0 i W/.t,, caG,„,,t 4 T7d N S „s /„... ,/e."1.:, CoP'-* f-/D , ti A <br /> ,f.� t <br /> Fee Rec: (10� <br /> 10 "i Q�I-v'�r/S i5 4 ” 1l�I G -- c71"-- Pe',"PA //4 r - Check#: p 51 y <br /> rri <br /> Date of staff site visit: Initials of site visit staff: >z <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: ilfr • - E: / Z Z <br /> 0 <br /> UPON APPROVAL: APP . CANT MUST POST COPY OF rf <br /> _ a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT5-:, li <br /> fill <br /> Transcendent: - Page 1 of 4 A v o coo <br /> Burnett County,WI Land Use Application—Rev 12/2020 °$ g N <br /> Laserfische: - < a, < cm <br /> e N <br /> U 3 <br /> 5 2 Nil <br />