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LAND USE PERMIT APPLICATION—Burnett County, WIcr <br /> .. N <br /> Applicant Complete All Sections Below This Line ° • e <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w o` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 N <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Nie Deck/Stairs/Patio/Retaining Wall/Sidewalk _Bunkhouse $250 z r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° d II <br /> Filling/Grading $150 Boathouse $500 0 �j <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 iV <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. po <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,5 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - A <br /> Property Owner's Name: 6r' G Shell i Ne--s S o o , <br /> Property Owner's Mailing Address: 3o 13 'Iver i_-ke_ KA Ai 8- 5. 4„41a^1 t4 117 $ <br /> i City State Zip b RS <br /> Property Site Address: 3'13'7 (�(�.\o nl2�� �1`. (/�?-6S+er— ; �/�/$ S cf$�3 v) <br /> Contact's Telephone Number: 6s (—3 fit'( -•737 _ c E <br /> � 1 0 <br /> Contact's Email: e r\L , nes s Lf 7-I (a 5►`'\ci) 1 cop.\, v a <br /> 0 <br /> co <br /> Legal Description of Property: Loi' 3 G..M V 9 P 12-Y g x Pc.l.- DeS #Y15436 o c o <br /> N <br /> Section#: %a Town#: -f 0 N Range#: 15 W Town of: etc-KSe� ° °' <br /> ro <br /> *Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property Page.* <br /> C7 <br /> Tax ID#(1-5 digit number;found on tax statement): '(-1q<0.- <br /> Proposed Use of Structure/Addition: Dad‹. v, <br /> Anticipated Start Date: Jur%.e_ t. � (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: Of\ '`,0-4.:\(�1 �H' <br /> I Ch.S'S Sewer Installer: H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY n <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 fir any dwellings,dwelling additions,manufactured homes,mtmufactured Z <br /> home additions,and bunkhouses.** z <br /> • <br /> x Fee Rec: l ,— <br /> cn Check#: q/94, <br /> 0 <br /> r- r"` r <br /> _ rn <br /> Date of staff site v I - 4hit s +f site visit staff: z <br /> APPROVED BY LAND SERVICES OFFICIA ! � p • - ���� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g,` = <br /> • .. --- iffl <br /> too 'V <br /> Transcendent: - Page 1 of 4 • 0 <br /> Laserfische: - <br /> Burnett County, WI Land Use Application—Rev 6/2020 rcz <br /> N. <br /> coligil <br /> �� J <br />