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CD <br /> LAND USE PERMIT APPLICATION - Burnett County, WI01 <br /> a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300rAddition/Alteration <br /> dition/Alteration to Dwelling/Principal Structure $200 e <br /> Commercial/Industrial Structure $300dition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 to Accessory Structure $150 J O <br /> a <br /> Accessory Structure(Commercial/Industrial) $200dition/Alteration to Bunkhouse $150 `; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk nkhouse $250 00 <br /> Driveways/&Campground Structures $125 State Statute 59.692(1v)Structures $350Filling/Grading $150athouse $500Six Month Camping Unit(One Per Year) $100rmit Extension(1 Year 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. a <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. CD <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: `0 <br /> city State Zip b <br /> Property Site Address: �3 ek r�, �� /G k <br /> Contact's Telephone Number: C o <br /> c <br /> Contact's Email: C-V- \ 'e- ' (V--, v--, d <br /> Legal Descripti n of Property: {Oct 1 �k eJ ) � <br /> N -p <br /> Section#:�_Town#:_�i" N Range#: W Town of <br /> 5 <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tar system ro er a e. <br /> P S .f .f� g Y P PY .f Y P P tY P g v <br /> Tax ID#(1-5 digit number;found on tax statement): 56,56 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C11 <br /> **The applicant needs to contact their UDCInspector 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.** %v <br /> 1 1 Gam" <br /> a NOOL �� I •y►�w't h�.b. .fi�� <br /> Fee Rec: l� <br /> v <br /> Check#: , <br /> Date of staff site visit: / �I Initials of site visit ff. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / 'n <br /> ca UuU <br /> UPON APPROVAL: APPLIC MUST POST COPY OF 5 w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Transcendent: - Page 1 of 4 N <br /> Laserfische: - <br /> Burnett County,WI Land Use Application—Rev 12/2020 <br /> a <br /> 3 <br /> b <br />