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LAND USE PERMIT APPLICATION - Burnett County, WI cr <br /> Applicant Complete All Sections Below This Line ' c <br /> Permit Types and Fees:(Please,check appropriate boxes) ',2:, N <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "c) <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 01 F <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 ° —1 <br /> Filling/Grading $150 Boathouse $500 �=• / <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 C <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. A <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory1structures,such as:pergolas,landscaping,etc. co <br /> o <br /> Property Owner's Name: '' it_ dam £_ c-3-1'1/4._ S /( z <br /> Property Owner's Mailing Address: l/ r i461T1Z.6.), 1cvi'- ei lam. 0 <br /> r���� AIUf / J <br /> r City State Zip $ N <br /> Property Site Address �� „�1f(;� = n <br /> cn <br /> Contact's Telephon Number: -� "' �1 o <br /> c <br /> f r t o. <br /> Contact's Email: CrA Set-/�� l v . ry t <br /> d <br /> E. <br /> Legal Description of Property: L* 1C...2 Ilk cat./--/,-Z) <br /> N V <br /> Section#: S6 Town#: /6N Range#: � W Town of: P -) j J a m %j <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> m. <br /> Tax ID#(1-5 digit number; found on tax!statem�nt): "9S36.1-1 <br /> Proposed Use of Structure/ ddition� riA 1 e/��_ ('`fr i' ' c, y <br /> C <br /> Anticipated Start Date: � , (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> Building Contractor: c J�/.1r—,11 (-_—, ' �' Sewer Installer:CC:jr-e_( �t� tl� <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U, w <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to v1 6- <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes,manufactured z -k, <br /> home additions,and bunkhouses.** xi <br /> ✓jeer 4.11 2. be8ro��s per 501420 -!6( <br /> l� dz� exp n�e� � ,� r <br /> 3 54.Yu'c�krc ✓n * be Co y <br /> s Fee Re: - <br /> F2 Check#: Q CX..V <br /> v <br /> Date of staff site visit: 4 /At 2.-P. Initials of site visit staff: a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: SA/e02- i `.—(�'/ <br /> a u"u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF fl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' o v �I' <br /> "icsD 3 <br /> Transcendent: Page 1 of 4 �,� c:10 <br /> '' j <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 3 <br /> UA0 <br /> LL_ JJ <br />