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LAND USE PERMIT APPLICATION — Burnett County, WI . <br /> Applicant Complete All Sections Below This Line ' C <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> '," r& <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `� <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150_ '� <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r . <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. <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. - 4 <br /> /) A , d4 . <br /> Property Owner's Name: ,/ r ‘,:G o • <br /> Property Owner's Mailing Address: 7a a0 m),44 Li '>)i14+ mil jJ g N <br /> � / i, City State Zip $ x <br /> Property Site Address: 07).2 Ail 2 N ,r a%4;;, L✓- E. <br /> Contact's Telephone Number: , 15- 2 2 —347 y=1 J G I1 1)p t- c <br /> Contact's Email: 79 ji✓L'4:6,fi (a ,cir ),l . /7v -- d <br /> Legal Description of Property: 1,�'1 2 ,3 re (//� vow, t i it 4h, 4,Yi) �! <br /> Section#: j t Town#: 9i.' N Range#: /y W Town of: 5�. 1" 0 °� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): i 5WY g' <br /> Proposed Use of Structure/Addition: 69.4-"7G '0 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x//'52./ <br /> Building Contractor: rs PT DM.., C 1l ' i; Sewer Installer: /L'' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <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 /> Drl1fe-I all St-�cks s <br /> kt' linu-n halm � ) s `Y 411/Y <br /> N�� -b �e Used -� <br /> = Fee Rec:1/6O <br /> Check#:iE 1(dp <br /> Date of staff site visit: /.{ `ii I1.wZ" Initials of site visit staff:"►(, { 4'(7 L_ z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 60/2629 m n In u u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a co 0 <br /> 7, co inN <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z N <br /> pon c=1 <br /> Transcendent: - Page 1 of 4 m 3 Innl <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 m = -- u u 11 <br /> u, <br /> 3 <br /> -o <br />