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LAND USE PERMIT APPLICATION-Burnett County, WI a I. r <br /> Applicant Complete All Sections Below This Line g N <br /> Q <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> J3 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> /Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 -- <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 . ��ejjjj r, <br /> Filling/Grading $150 Boathouse $500 t- <br /> 9. <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 squired 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. l' ��� <br /> *Items not listed above will be treated as accessory structures,� such as:pergolas,landscaping,etc. i C./ <br /> 4 /i_d_ L -0 :4„ /l J� <br /> PropertyOwner's Name: r -� o <br /> Property Owner's Mailing Address: 7636" OjC i W/¢ k/' ZcS - 1893 g <br /> /, , J � ��� Ci ,/ tate Zip 41 <br /> ?,Z� <br /> Property Site Address: ( /,?z F l� GC/Ems "-'Z' �` /3' ° z It <br /> Contact's Telephone Number: 7/ — -790- 7A3.? (-in de etd( o N <br /> CD <br /> Contact's Email: Z,r/>i t r, kJ' 4 n2421.(2J o.d <br /> Legal Description of Property: ki e- <br /> JVv" <br /> j N '17Section#: 7S Town#: 40 N Range#: /6 /JET/VW Town of: O a.k 1 0 00 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> m <br /> Tax ID#(1-5 digit number;found on tax statement): J"1. 5. <br /> • o, <br /> Proposed Use of Structure/Addition: I/L <br /> Anticipated Start Date: p—11 _ i,- bin;Commercial 'us: ess;Bedroom;Deck;etc.) <br /> o <br /> 1 t7 <br /> Building Contractor: 4, / /c c t t r I.—/. er: <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 bunkhouses.** z <br /> - No/ 6e_ Use. .� A4 me(vi ;qb/'7-4>4 '.0//t,, <br /> s Fee Rec: 1,-,c--n - <br /> ' d <br /> y Check#: S'"2- <br /> / Q tr <br /> Date of staff site visit: 6/ZZ/� Initials of site visit staff: J"/ / z <br /> ®® r <br /> APPROVED BY LAND SERVICES OFFICIAL: , DATE: / yot7 ! ( � j j <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF y r- <br /> . <br /> �[iiiil <br /> a c_. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . co z <br /> ififil <br /> Transcendent: Page 1 of 4N n co <br /> Laserfische: Burnett County,WI Land Use Application—Rev 6/2020 < .s ry <br /> p W Z N n <br /> C Yr" <br /> `- JJ <br />