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• <br /> LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 'CD 7 W <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> Dwelling/Princi pal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0,0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ')\ q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> r <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. c <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> $ • <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. m I • <br /> Property Owner's Name: ref,v/ 60rs k—! //// z ' , <br /> Property Owner's Mailings ess: 725 4/� de S 4// /%44/o � fr A/ i F,7 <br /> 0 <br /> t — x / <br /> ��/C) // City State J/S <br /> Property Site Address:3 - ^ � � OC4bv,"y VI// 7• n <br /> Contact's Telephone Number: Gs-/—Z4o^ V7,03 '� o <br /> Contact's Email: pr7✓G+O ,� <br /> rSt l Gr���. COn�7 • d <br /> Legal Description of Property:V ?5t'" Ake.oham Pr'✓a.E.I/iw irelee LDl-Z ,&. /a <br /> N '-0 <br /> Section#: 5/q Town#: 05A/ N Range#:/G k/ W Town of: k—,/4. t41 o w <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> * °O <br /> P g f f S Y Y P P tYP S 4 <br /> Tax ID#(1-5 digit number;found on tax statement): /970 <br /> Proposed Use of Structure/ ddition�4. -cite <br /> Anticipated Start Date: !�! (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) r)11::>) <br /> o <br /> N <br /> cA <br /> Building Contractor4 krt ,ljiwer Installer: /�/ft <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY tp <br /> /� <br /> fji <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 <br /> home additions,and bunkho ses.** p, <br /> (5►'fee q,k tour li.s,.. <br /> ivy- -tJsnGI,•6;. -7 " <br /> Fee Rec: `P—C.J'— <br /> cn <br /> / 2 �/ ,4 Check#: (p//' <br /> Yi <br /> Date of staff site visit: S/ ! _3 Initial of site visit staff:T! <br /> CA <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> frfE to ' 1 <br /> e DATE:5/5/a3 < ._,&1:2, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a milig <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 5 ^_ trH <br /> Transcendent: - Page 1 of 4 M u N <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 m ca <br /> a fill <br /> c. <br /> J <br /> i <br />