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LAND USE PERMIT APPLICATION- Burnett County, WI a <br /> Applicant Complete All Sections Below This Line =' c <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> P <br /> • Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 -,-.3 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `vs.) <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <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 0 16. <br /> Filling/Grading $150 Boathouse $500 0 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 ' • <br /> *NOTE:After-the-factermits <br /> p (permit squired 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 9r. i <br /> Property Owner's Name: 1 Lj' r y �2(M'v1ci10 Sr, o <br /> / n -, r <br /> Property Owner's Mailing Address: d.5-Ti ") S A.,ti)cjn7 Rd (!ravkt y 4: S'/ 1 o <br /> Q <br /> �1 City p State{ Zip <br /> Property Site Address: ,�G', 9 -e n <br /> Contact's Telephone Number: /5— y 403 33 4,(p /Cet'I -its-22 2 c( ? `-1 o< - <br /> Contact's Email: tfject nc�,p 15-37 p 0",„ I , 06 rvi 0 d <br /> Legal Description of Property: Al,5:52)' o E 3 10, /V Al til <br /> Section#: Z Z Town#: 3 9 N Range#: i C( W Town of: t4e5t rrnar5I 16,,, l) _ °' <br /> 5' <br /> °;*Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> G <br /> Tax ID#(1-5 digit number;found on tax statement): ( .--)g 4 k <br /> Proposed Use of Structure/Addition: S'fd rel ,~ J 0-1\8oiu1/4.kpke_ )e4 y�'�'O `A <br /> Anticipated Start Date: AP (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o k <br /> " �4 <br /> Building Contractor: Sewer Installer: <br /> 6 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .S <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 to6,04 <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z <br /> home additions, and bunkhouses.** <br /> i,1 OA-- -j'- Ic a iv\ah RaMthov\ <br /> 0 <br /> Fee Rec:114auQ <br /> o Check#:(1;Ise- <br /> = <br /> Date of staff site visit: �'/r —.D--(30--. <br /> c—. itials of site visit staff: Y z U <br /> rd <br /> mm n <br /> APPROVED BY LAND SERVICES OFFICI• DATE:`)Y - a a< <br /> rxmC u"u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT V <br /> 3. <br /> Transcendent: - Page 1 of 4 i c (�U <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 t n ` J <br /> a <br /> K <br />