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LAND USE PERMIT APPLICATION- Burnett County, WI a C <br /> . b <br /> Applicant Complete All Sections Below This Line 5� CD o <br /> Permit Types and Fees:(Please,check appropriate boxes) ' a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �� <br /> K, Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 k' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 r� <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w 1 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. X <br /> *Items not listed above will be treate s accessory structures,such as:pergolas,landscaping,etc. b P <br /> r r— <br /> o r. r, <br /> Property Owner's Name: re, E1 L LS .z C I z kA <br /> Property Owner's Mailing Address: //3/ ( (o( w Fl�) �y mora)rt o. <br /> ,� <br /> 5/K0(7) <br /> ��> W City State Zip <br /> Property Site Address: l O r el 4_ <br /> n <br /> f\61 . <br /> Contact's Telephone Number: &-7--5--/ 5 9.y `C "N so G <br /> tfc�T _ a <br /> Contact's Email: ©+42 ;.A 5-r-3— <br /> �-- ® d <br /> FD <br /> Legal Description of Property: e2 t(( 1..-,Or / C$ 144 .—V (5 19 4 <br /> N <br /> Section#: ;(n Town#: 3 g N Range#: i'7 W Town of: r-P r.i ( 21-1 5 °__ 0° <br /> cm <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number; found on tax statement): a-3 c . <br /> Proposed Use of Structure/Addition: G ca V`a/ 2_ <br /> Anticipated Start Date: ,3o 4N.-e.._ l tZi.o;z- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) £ x <br /> Building Contractor: <br /> Sewer Installer: -3 <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.** �' <br /> wo--Fof-- <br /> 0-arroW Pre-birk <br /> moo <br /> Fee Rec: l <br /> F?: <br /> Check#: 3s I <br /> rr <br /> Date of staff site visite O�c)--C-)Initials site visit staff: <br /> 1k Eiz <br /> (A ____ ,L__...71 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 'I p 40 li liM <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF :u g 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT boo N <br /> -tm = N % <br /> Transcendent: - Page 1 of 4 m v <br /> 0 <br /> Laserfische: - <br /> Burnett County, WI Land Use Application— Rev 6/2020155 <br /> 4y Q <br /> K <br />