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b <br /> LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> a I ro <br /> y N <br /> Applicant Complete All Sections Below This Line o' co, o <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ;•:, 6.).., <br /> d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ....e. <br /> ,'Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 cr-cO <br /> AccessoryStructure Commercial Industrial <br /> (Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse $150 P' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 i i 3 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r, <br /> Six Month Cam One Per Year ° <br /> in <br /> p g Unit( ) $100 Permit 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. k <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. ro <br /> Property Owner's Name: _m '_CIS cl t'I v- 6Qi rov IJ('0/1--- ° z <br /> y o <br /> Property Owner's Mailing Address:_ ' � 0 NI(, Lou, i enn^ ! (CLQ Th/ . : 35/ • o t� <br /> Property Site Address: ''i I �3 City State,, Zip <br /> .� � 3 `� l la f_Dh:Sp�i�J I�'n LS z <br /> Contact's Telephone Number: 4/2 `R3T <br /> ' 6/^238 OF S �r� `��� o &, <br /> • <br /> YY�Ca S 1, Ah-f ® a <br /> Contact's Email: <br /> �rvn�- 1r1��1 � Co � d <br /> Legal Description of Property: ,p4 /12/ iIriii Q- YV /li,� tl0�?nec Df-Splei] <br /> /--,C4 AA'' <br /> N b <br /> Section#: Town#: N Range#: W Town of:_ (rc _ a w <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> tA <br /> Tax ID#(1-5 digit number; found on tax statement): 3 3� J y <br /> 5.. <br /> Proposed Use of Structure/Addition: 6C\y' C-)'e . <br /> Anticipated Start Date: _ v (Home/Cabin;Commercial Business;Bedroon;Deck;etc.) o <br /> Building Contractor: a Sewer Installer: <br /> AREA BELOW THIS LINE,FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y <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 far any dwellings, dwelling additions, manufactured homes, manufactured z k <br /> home additions, and bunichauses.** I� <br /> • P-2rrn —r,euro,e ;,l lag n ci l r°-pe i.--'i-Y . 'f <br /> f ec _ l -W <br /> o No-t-- Fa 4 u ie / n1 o 1A-0-- ort <br /> _ Fee Rec: 150— <br /> (---,?(J0 4 Check#: '' <br /> 0 <br /> of staff site visit: I is of site visit staff._ 1u - <br /> Date <br /> APPROVED BY LAND SERVICES OFFICIA • <br /> DATE: 6-27. <br /> 69,04?0, J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFgo <br /> . <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT '3 a) z <br /> 0 <br /> N n OD 511 <br /> W <br /> 1V <br /> C C� <br /> 'Transcendent: - Page 1 of 4 .o R. <br /> Laserfische:_ - Burnett County, WI Land Use Application—Rev 6/2020 . 3 <br /> Eli] <br /> L�`::D.J <br />