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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line 5 c JP <br /> t..4 <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 P <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 4 ---, D �) <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ^ R, fiD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 i ''-- <br /> n �._._J <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o �/ <br /> Filling/Grading $150 Boathouse $500 , <br /> ,--. <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. Eg <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -( f <br /> // r r' <br /> , <br /> Property Owner's Name: ea44 �� l e As S o z t <br /> Property Owner's Mailing Address: t)9 0lelem 1 4110—by (/ /1 $5217 g <br /> y State Zip v ' <br /> Property Site Address: d ` 0 ,4 7—../.44/0460 1J elJC 830 . <br /> ik ("") "441. <br /> P /�— 75 O — 09 o< <br /> Contact's Telephone Number: U� o <br /> a <br /> .. <br /> a <br /> Contact's Email: /(y. e tzr 0 $4 /14 ,. me/- d <br /> Legal Description of Property: fee 6 l) ,9 fc <br /> Jo ao <br /> :F..) <br /> Section#: O"7 Town#: rO d N Range : i'�ti/ W Town of: /s,,i! , /i ,i� : • /,, = <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property pa.e.* p <br /> 7, <br /> Tax ID#(1-5 digit number; found on tax statement): i'fr) 6 i <br /> Proposed Use of Structure/Addition: Clifil <br /> /. i <br /> Anticipated Start Date: a—/ 7— 2,2 (Home/Cabin;Commercial Basin,.• s;Bedroom;Deck;etc.) C. <br /> 0 „...i d <br /> Building Contractor: 4/7E Sewer installer: C Li.-44 o4 g <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/ ONDITIONS ONL <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <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 <br /> home additions, and bunkhouses.** <br /> Pille4 1I s OPOcjILS X.. <br /> WRIVC-Ilb 110+ -4 ekc.e.ed a bd i s j( 9I- 3, a34 <br /> Fee Rec: 3a <br /> Check#: Z-7.2.'i <br /> �laq/ _ <br /> Date of staff site visit: �� Initials of site vis' : % �I • v <br /> APPROVED BY LAND SE-6/ t / / d' i <br /> SERVICES OFFICIAL: /AAA ► DATE: qt 3D <br /> Z <br /> O. WI <br /> UPON APPROVAL: APPLICANT "UST POST COPY OF • m W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTa <br /> t RN, ! <br /> f K <br /> Transcendent: - Page 1 of 4 c <br /> Burnett Count WI Land Use Application—Rev 6/2020 <br /> Laserfische: - Y� AA i <br />