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S . <br /> c41 <br /> LAND USE PERMIT APPLICATION—Burnett County, WI cr g <br /> Applicant Complete All Sections Below This Line n 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) a' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure 1.9( $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) S $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ---+ <br /> ro <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 0 4 <br /> Filling/Grading $150 Boathouse $500 o MV <br /> VJ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r` <br /> 7. <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. '‘;`: ..,....\. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: ( o <br /> I III <br /> .if I -n <br /> Property Owner's Mailing Address: al"f ,Q 1 ,W I �t °o '� <br /> / '1 '/fJ y G state Zip ro <br /> Property Site Address:a\ \ 2 A6tRY-1,'V/1 AlA 1 C/I�C>1 . +:' <br /> p —11�—` O � e <br /> Contact's Telephone Number: � -�-, ,'2. ' <br /> /� 0 • <br /> Contact's Email:T\) I e �` Iq3"7--glifral I . '1 V 1 �j d 1 <br /> Legal Description of Property: <br /> \ 1 \\2\ V' IA .�, ¶ :::) <br /> CD <br /> 2Q <br /> 5 o0 <br /> Section#: '6-3 Town#: �J \ N Range it: 'O_W Town of: 6 , _ . ,�r <br /> *Attach additional page if needed for lengthy description ORattach �y of he deed OR attach tax system property page.* C. <br /> ----I, <br /> Tax ID#(1-5 digit number;found on tax statement):r (r��`/� /�-�/� <br /> Proposed Use of Structure/A diti : ®1 e �,V.e 3o ix Lic r V t' l Anticipated Start Date: \ (Home/Cabin;Commercial Business;Be r om;Deck;etc.) (� -, , <br /> '�` `W\( W d <br /> Building Contractor: Sewer Installer: <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <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 N <br /> home additions,and bunkhouses.** <br /> 0 Ii II 3 dT es - 5 3 4 IUO -fir Autn J ,Qt_t_ <br /> k .b. -k'c ) <br /> M(17‘,J <br /> 'c ti I.( ► A - 1,4 bi Bl(03 z Fee Ree l�/S <br /> oi <br /> ® Q <br /> Er. <br /> Check#: �� 1 <br /> rri <br /> Date of staff site visit:1403 Initial of site visit staff: )45 r <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Li/111 2 3 a) <br /> u cri E <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a CZ <br /> _ N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a <br /> CZ <br /> Transcendent: Page 1 of 4 (71 <br /> Q co <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 R <br /> m ....1 <br /> U U <br /> a <br /> 3 <br /> -o <br />