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LAND USE PERMIT APPLICATION— Burnett County, WIcr <br /> ' . tJ <br /> Applicant Complete All Sections Below This Line - <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `"J �, <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `"Jr <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $1500 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 n V,° <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Per Year <br /> p g Unit(One ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 3 <br /> F. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. , <br /> r P. .. <br /> Property Owner's Name: r Co/ , , , j .14-- ® ,�J 0 o <br /> Property Owner's Mailing Address: 4' /v ,. f ,,< 4*e ,(,� i Ye eki,.i2 Y17A o <br /> City State Zig $ <br /> Property Site Address: 505-(9./ M •Lie_ Aea 5 3 4-9 ". n <br /> Contact's Telephone Number: 743- `-71V -0 7...2..c) @e//, o <br /> Contact's Email: . LP, 71 A ,gLap7C..,4.,'4. . 0,4- d <br /> ,t <br /> Legal Description of Property: ' L 4 e.5m , 17 V .1 P 023-d "L/43 �;Z. <br /> N vo <br /> Section#: 0)-It Town#: 9/ N Range#: /,j W Town o£ ....5-it)if S 2 <br /> . <br /> w*Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system roperty pae.* <br /> d <br /> E. <br /> Tax ID#(1-5 digit number; found on tax statement): . -/515;2. <br /> Proposed Use of Structure/Addition: /I)45-/F S/es1 e-.S <br /> Anticipated Start Date: Mi �� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o w <br /> x <br /> Building Contractor: Sewer Installer: ` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ^. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> .I_VYconstruction taking place for any dwellings,dwelling additions, manufactured homes,manufactured Z <br /> home additions, and bunkhouses.** <br /> • move Cil\ c}-a.\(e o \ea3-F- ©_ 'kkE <br /> 1-04V\ e S;c e t) le s"N (.., i i-\'2 <br /> ary\ex- <br /> x INInc t 0 ;4. �'�� s'Th 6 k- .S <br /> n n co <br /> C 1�r. Co.i Fee Rec:1 <br /> Check#: /3018' <br /> 0 <br /> Date of staff site visit: 1e- 0 8 Init' s of site visit staff: R.V---- z <br /> l J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ! i� a v < n <br /> ci a """ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF -i z z <br /> CD [511 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° oo co <br /> Transcendent: - Page 1 of 4 3�` �' <br /> Burnett County, WI Land Use Application-Rev 6/2020 n o N� <br /> Laserfische: PP o <br /> 0 <br /> > <br /> K <br />