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LAND USE PERMIT APPLICATION-Burnett County, WI cr g <br /> Applicant Complete All Sections Below This Line 5' c <br /> Permit Types and Fees:(Please,check appropriate boxes) o- <br /> ,./ Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> `' <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Q <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 `° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground StructuresC) _ <br /> $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 a <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> _NY <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> "ff \ <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 /> r—._ g. <br /> Property Owner's Name: I l r•-t `I-7Z eon ivs-tti e...1 I'1 6-4-- z <br /> 0 <br /> Property Owner's Mailing Address: 3 Z"}zo e_2oy Avg `/ `/rls. Mil `SSD 33 0 <br /> S 7 `l ImIP <br /> City State Zip a <br /> Property Site Address: /179-f e205 c✓ g .. n �=� <br /> a C ' . <br /> Contact's Telephone Number: , $7– to Os-53/ Z oE <br /> Contact's Email: /ham/I'1�/'��7 e,S 6C-4'',`t`/� S. ea/'1 0 a r <br /> ro <br /> Legal Description of Property:i�stedd I Id/ ".p C7/4 01/7 . I 3/#fez x.1"3 <br /> Section#: ZS-- Town#: 37 N Range#: /1 W Town of: [Noodc. Alia- 0 °O <br /> cro <br /> *Attach additional page ifneeded or lengthydescription OR attach a copyofthe deed OR attach tax system property page.* <br /> * <br /> P8 f Y P P tYPS d <br /> Tax ID#(1-5 digit number; found on tax statement): 3 2 it g 6' <br /> Proposed Use of Structure/Addition: /i <br /> o <br /> Anticipated Start Date: 7//La (Home/Cabin;Commercial Business;Bedroom;;!o Deck;etc.) I <br /> Building Contractor: .'ai 4-4 'ay 41I f#Q- Sewer Installer: r o s S /4/A IL/L t <br /> -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/COITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <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.** xi <br /> 141 <br /> Fee Rec:$3Q74 <br /> L Check#: ,Z5 <br /> Date of staff site visit:/ / / D `' ti, f.ite visit staff: -)\\L— - <br /> - 00APPROVED BY LAND SERVICES OFFICIAL: ( �� i • —�� °' jib <br /> a t.,.. <br /> W 03 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,� CTranscendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 -- <br />