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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a g �,, <br /> Applicant Complete All Sections Below This Line 6' fp 1 <br /> i� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> i9 <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 $150 K q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 <br /> O. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> ZD <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,& -\\I-, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 1 `d�1-Y,ki'C1ir\ s a V"" z <br /> 0 <br /> Property Owner's Mailing Address: 2 g Oi, /,947111V L(, ck41 l 567 a <br /> City State Zip ' <br /> Property Site Address: SCL,'C�"-c--- rn <br /> Contact's Telephone Number: I (4' C 7 om$ 6 3 Z C <br /> Contact's Email: c� 150 IN b 1 ' lcQ, ri.--)C—,(' C Q 1Y--- d I <br /> Legal Description of Property: LO? (5 (5 r4 V Z RIM <br /> N 'V <br /> Section#: ZZ, Town#: 4' N Range#: /,S W Town of: 0.0 k SU- =. 00 <br /> b <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): 3 3-S ! <br /> Proposed Use of Structure/Ad hon: Qc 'O.�€._ ''C7 Io �p <br /> Anticipated Start Date: 9 2.1 /2.2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C- o ,x <br /> 1C) ti <br /> Building Contractor: Sewer Installer: <br /> y W <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z l'----- <br /> home additions.and bunkhouses.** <br /> 0 rna4 4(1 Se-l-bc, I <br /> OW- -Sw( h LA(IA Ail abMso 4 iI <br /> Fee Rec: /5 <br /> 9.'/ <br /> /A? / _ Check#: 1402,7rn <br /> Date of staff site visit: 1I6Initials if site visit a v <br /> /, . .,1__J--D <br /> 1.P Y LAND SERVICES OFFICIAL: A , DATE: I/.8 <br /> ! PROVED B I�.ai. . (?, 0 fill <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF 4 g W I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2 o o <br /> ), <br /> Transcendent: Page 1 of 4 n m �a <br /> Laserfische: Burnett County, WI Land Use Application — Rev 12/2020 ; gIiiiii <br />