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LAND USE PERMIT APPLICATION— Burnett County, WI a g <br /> '� N N <br /> Applicant Complete All Sections Below This Line 5 e <br /> Permit Types and Fees:(Please,check appropriate boxes) ° C).1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> )G Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> PO o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Wall/Sidewalk Bunkhouse $250 C� Raj <br /> P <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e �P <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 ,fi <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t <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. b , <br /> o <br /> g. '` <br /> Property Owner's Name: Cob Z.4 A- 8,..A• - z l <br /> a 1. <br /> Property Owner's Mailing Address: 7155li"1:4,4-r- Lam.. ./VS/4% ttie/te, v..." 'se,--t 8 <br /> City State Zip -0 <br /> Property Site Address:, (5"`2©d Ct ( T nn <br /> 4 <br /> Contact's Telephone Number:6 ( C('I9- R 3/1 Z, _ N <br /> O E. <br /> Contact's Email: Qti5ea`. Rec.ick.os e PtS A . Co.W\ -e <br /> .. <br /> Legal Description of Property: <br /> 0 00 <br /> Section#: Town#: N Range#: W Town of: �d -sciN <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): ,S�O5E. <br /> Proposed Use of Structure/Addition: G t--eq..," ti-ti L S e `n <br /> Anticipated Start Date: -� <br /> p A-S/T'P (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: Yee Sewer Installer: <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 /> -1.VYconstruction taking place for any dwellings,dwelling additions, manufactured homes, manufactured z <br /> home additions, and bunkhouses.** <br /> 1\)61--- <br /> 4M/ 1 /1 4 ti-6,N11^°n <br /> Fee Rec:/r12 <br /> Check#: <br /> y 1%tI <br /> M,Y...----- <br /> rn <br /> Date of staff site visi �� `�o- I itials of site visit staff: z <br /> -9— 'rte-_-- <br /> APPROVED BY LAND SERVICES OFFIC DATE: ____ <br /> m <br /> UPON APPROVAL: AP LICANT MUST POST COPY OF m IM <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' 5 ETii <br /> D O O <br /> Transcendent: _ Page 1 of 4 CD K o <br /> Laserfische: - a, ifila <br /> Burnett County, WI Land Use Application— Rev 6/2020 4 <br />