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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> a g <br /> , 7' b N <br /> Applicant Complete All Sections Below This Line 5� s•N <br /> CD i <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 e <br /> w <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 �O <br /> Accessory Structure(Commercial/Industrial)' $200 Addition/Alteration to Bunkhouse $150 e'N...`g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> P <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r 1+ <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: l"l' /ej Fi:i A z <br /> / o <br /> Property Owner's Mailing Address: 1 O S 5 gi'O v C g ca '/c& fr) AL S '3 C) -i <br /> City t State Zip to <br /> Property Site Address: fa"'�t- a• ram„ <br /> Contact's Telephone Number: 'J /— D S-3 Y 5-3— <br /> o y <br /> Contact's Email: CX 1✓/rS 7c_, 4 ,15.t 0 1744 GO. Cu in .� d <br /> Legal Description of Property: Let / Celli/ V. 9' 4 /zz__. c„ <br /> N -o <br /> Section#: CV Town#: C) N Range#: / W Town of: Sc d r 0 °G <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): / 7 7J <br /> Proposed Use of Structure/Addition: Al) L+h el u 4 v‘.1 t t heir't-- r°X IS r ti5 Lj.l t'4Id ti(0v i 11 <br /> Anticipated Start Date: /11) 2c:J 2-7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: )--i t /iOwSe hh c .i' ' S Sewer Installer: 1//A t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to NO <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** / x <br /> i) ,V o a�y�lda(47 �f%4�c9d 54�t l l'' S S� /s <br /> y� y � <br /> oel/ ,, z <br /> / tel -6'//' 4eltive9/14S . <br /> Fee Rec:�COcb <br /> K <br /> 0 Check#: Wet <br /> m <br /> Date of staff site visit: l0 2$ Ze22—Initials of site visit staff: / ED:: <br /> APPROVED BY LAND SERVICES OFFICIAL: �1TE: �� 0eZ 7 UPON APPROVAL: APPLI ANT MUST POST COPY OF SIGNED PERMIT APPLICATION IN PLAIN SIGHT Transcendent: - Page 1 of 4 Laserfische: Burnett County, WI Land Use Application—Rev 12/2020cA <br /> 3 <br />