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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> g <br /> b <br /> Applicant Complete All Sections Below This Line c <br /> Types and Fees:(Please,check appropriate boxes) °- <br /> Nelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Is <br /> )mmercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,� '� <br /> _ <br /> :cessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> :cessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 n <br /> .ck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C I^ <br /> C <br /> -iveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures . $350 ° <br /> Iling/Grading $150 Boathouse $500 r. <br /> 0 <br /> x Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 V <br /> cn <br /> After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. r , <br /> ,unication Towers&Signs require a different application form;see corresponding application,and fees. <br /> not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - ,,n •� <br /> rJ c R <br /> y Owner's Name: 0 a-fa L ct 4 V kin il i'1 9-,°I-- z <br /> 0 <br /> y Owner's Mailing Address:_ 2 cf..; A 49"ie. ,/ A- yr iii MA,c-)it,. 140 5592- 0 <br /> 441761.(4) <br /> tate Zip ivy Site Address: g 1O/3 . `* 61(e-i/Wi <br /> ti 144 E. C <br /> 's Telephone Number: b3 —Y 7' —5*--2 "I ( — o E <br /> CDCD <br /> 's Email: Cpr�*4 C7ee-., Ca-$T , e 1111110.- d <br /> AD <br /> Description of Property: <br /> 0�i ytait pfry.t `fr <br /> N ro <br /> #: Town#: N Range#: W Town of: a° O <br /> additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c' <br /> #(1-5 digit number; found on tax statement): j <br /> d Use of Structure/Addition: yo r+• <br /> tted Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Or" E x <br /> Contractor: re G F Sewer Installer: C7 0 It IJ �- � <br /> BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Ci' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t_. .Z. <br /> applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> additions, nd bunkhouses,',* <br /> ;o <br /> ) Q.et se- bc,.G <br /> el"MA- ell(eS 70;1?2- <br /> z Fee Rec:3f)jC <br /> N Check#: 3 <br /> 0 <br /> �/?d1 �, <br /> staff site visit: Initials of site visit staff- a <br /> / z <br /> o, ' .�1��-lel �--.�J <br /> ,VED BY LAND SERVICES OFFICIAL: _ <br /> 'L•G� ✓ ��' DATE• <br /> iN APPROVAL: APPLIC ��MUST POST COPY OF <br /> GNED PERMIT APPLICATION IN PLAIN SIGHT n ...... G� <br /> O c� <br /> endent: Page 1 of 4 z �N. <br /> r.ische: - Burnett County, WI Land Use Application—Rev 12/2020 ...c <br /> Inill <br /> (. -2)I <br />