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LAND USE PERMIT APPLICATION- Burnett County, WI a C <br /> b <br /> N N <br /> Applicant Complete All Sections Below This Line 5' = e <br /> Permit Types and Fees:(Please,check appropriate boxes) `- <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ' <br /> n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 <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 °< fit <br /> fling/Grading $150 ��athouse to o <br /> / it •ix Month Camping Unit(One Per Year) $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. a cil <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. <br /> co <br /> Property Owner's Name: / j/ - <br /> Qi e- (�,/ j -A o o c) <br /> Property Owner's Mailing Address: 2 7 /e.)-7 r- 19/ //e Al � 1/-2 o <br /> � it tate Zip <br /> City 0 0 <br /> Property Site Address:,, d"'/ o, a. <br /> 474 [_/, , i 1 <br /> Contact's Telephone Number: ! ` 2Q _ 01-4 o <br /> • CD <br /> ro <br /> Contact's Email: /04- ..d <br /> Legal Description of Property: 1jd C. <br /> 7 is p" 1 Z/cto <br /> /� tt N . <br /> Section#: W Town#: tip N Range#: /6 W Town of: Da k/c N d <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system propertyPa page.* <br /> W. <br /> Tax ID#(1-5 digit number; found on tax statement): (30 c <br /> Proposed Use of Structure/Addition: 0 CJ J�01/UI f ZJc cra <br /> Anticipated Start Date: (Home/Cabin;Comm a1 Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: ,t?jr cS' Iv -h, e?Sewer Installer: 'A / l i -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A <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 p <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured Z P (tel <br /> home additions,and bunkhouses.** <br /> Ca ? asd AUs yrud 1 6e91-oredi /pi s Ltdt104;4y <br /> ®v' p+ew,e cyc,w+ Jie, P t'/9 ,l Ay I©/11 LZoZD <br /> — Mc/ y N v'� 04441/ fMet/ .114,e Hit c-e—A �i /t y 10/12.4020, lb <br /> -�f 1-411' /s OM 5/0". 6e .e.,1MIJ11- G u ` 1 !p /J/O Fee Rec: .� <br /> / E: Check#: ', <br /> Date of staff site vi6 - ' Initials of site visit staff: , � <br /> rads � V' ` <br /> z <br /> CAr' <br /> APPROVED BY LAND SERVICES OFFICIAL: (�.• DATE: 7 a/ U <br /> WZe9 r �)/` <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF (D C rg <br /> G <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° 0 <br /> Transcendent: - Page 1 of 4 n <br /> Laserfische: Burnett County, WI Land Use Application- Rev 6/2020 g 0 <br /> K <br />