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LAND USE PERMIT APPLICATION- Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line a c <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 i <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 J ' <br /> ...� <br /> X 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 o 11 <br /> Filling/Grading $150 Boathouse $500 0 <br /> • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> Cn e--- <br /> r,,, <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. ^,c <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> }� o �' <br /> Property Owner's Name: )AV, ► t I ' Y d I N(T— .-4.• <br /> 4. <br /> � IM �l S J^ Z -� <br /> Property Owner's Mailing Address: 1 / 7 -1--1 L 'eAt-+c1 1c v.e `1161 I $ <br /> l ity State Zip $ <br /> Property Site Address: a•g�4D V I e V r,✓-Q._ a. 19ts ✓t/ <br /> i of <br /> Contact's Telephone Number: `Q l I —1 O / --`o lab F <br /> R <br /> Contact's Email: � ,,,► I(. i z \/t,vA)G— �3 av1e-.S • LII o <br /> ! i ED <br /> L 1 <br /> Legal Description of Property: Lo� S �S� � p V�( � / �' � 60„ <br /> 0�' d�_ <br /> J N C <br /> Section#S a Town#: Yo W N Range#:R i (s7 W Town of: ©, klc(✓t.d _. °0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number; found on tax statement): 1 3 S S -7-- <br /> Proposed Use of Structure/Addition: ?c! <. 3 a ri.‘ cn <br /> Anticipated Start Date: ! -� w <br /> )�j C�2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: 4 O,,,k-,Zo 1drv_<, Sewer Installer: AIM— <br /> -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERIVIIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: j <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> A.VF construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z <br /> home additions, and bunkhouses ** %: <br /> dr ;'itekAy <br /> i• cx.:,, $, A-- L - ' PA; 11e-r 2‘4 -r r 7 r <br /> Co( A- e:A- -Too\c . Se r V e ce S "�a'r /'l e-t lJ o s S � <br /> Fee Rec. I,�(" <br /> Check#: 5urah. <br /> N\1L--- . <br /> Date of staff site visit -- tc ''..-�l0 Init' s of site visit staff: z <br /> � <br /> jam �� <br /> ('Q <br /> APPROVED BY LAND SERVICES OFFICIAL j ATE: 2 ' ! ---‘ 07-‘2) <br /> ‘ �' r r � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W <br /> IV !Mil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° c 4061 <br /> Transcendent: - Page 1 of 4 n m Q <br /> Laserfische: - <br /> Burnett County, WI Land Use Application— Rev 6/2020 < m EA <br /> -a <br /> >, <br />