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LAND USE PERMIT APPLICATION — Burnett County, WI 0 b <br /> _ Applicant Complete All Sections Below This Line 4o <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ...., NI <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 w' O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ?' <br /> Filling/Grading $150 Boathouse $500 r `/o ' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ' <br /> s , <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,- , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. CD <br /> Property Owner's Name: c � <br /> Ae Amc ) —I f:56:1/4/ <br /> C <br /> Property Owner's Mailing Address:539'4/'I C-ry RD C , c) `, 1 � b: �$a j <br /> City State Zip <br /> Property Site Address: C .ter AA)` t. <br /> __ 1 �I ` ^ E <br /> Coll <br /> Contact's Telephone Number: W i o�1p-�,..5 6c1 ECIAAD)/ 61 Z. c1�0TI 5' zi(Aimee)) o• F <br /> Contact's Email: Iib Q51 1007 e.orict'l d <br /> Legal Description of Property:CAN .044Pi) t' Lir J/PIN: 07-o12-j-qo-Is-- ($-s <br /> Section#: Town#: N Range#: W Town of: - W: 15 o?,7-01bv0 ,70 <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 /> d <br /> Tax ID#(1-5 digit number;found on tax statement): b22(40 c)" <br /> Proposed Use of Structure/Addition: 5-1Q C3� "' <br /> o P <br /> T <br /> Anticipated Start Date: V52-02,0 (Home.Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> l/ <br /> Building Contractor: 3OD , F1=C.'.1--- Sewer Installer: N/A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY >j <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 /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** Pc)`��`� z <br /> NI0.A-- -- �tl.V a h <br /> Fee Rec: L50 <br /> W <br /> Check#: 143Date of staff site visit: ��� _c ) 27:40 <br /> nif fials of site visit staff: ,____K .l <br /> . ' <br /> ft.1\40_,. <br /> APPROVED BY LAND SERVICES OFFICIAL DATE 3e < .r <br /> tAa <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a „m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0y 0 — 15i1 <br /> .‹ 0o O <br /> fD C r•...)Transcendent: Page 1 of 4 o <br /> rso `Z <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 6/2020 m <br />