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LAND USE PERMIT APPLICATION—Burnett County, WI cr r <br /> ro <br /> Applicant Complete All Sections Below This Line n cn o <br /> Permit Types and Fees:(Please,check appropriate boxes) o. c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `o . J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> AccessoryStructure Commercial Industrial a <br /> (Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Z <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 6? 1 <br /> Filling/Grading $150 Boathouse $500 r lh <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 P <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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 /> Property Owner's Name: At r %lI' i/z g ,9e7& E.& j! z I, <br /> 0 <br /> Property Owner's Mailing Address: a2 7 /�t9 ;/ / Ei) Idj -5-fiizi o ' <br /> City State Zip .o 111, <br /> Property Site Address2 74/5-1SW/LW- kb kVS'j -T-5-Ye9 = n <br /> Contact's Telephone Number: l g 9-36,3 3„ sm7.3 ' o r <br /> P <br /> Contact's Email: 0.9/2 / //°Kg / 60 7//HIV A ee. 0 d <br /> ,_, <br /> Legal Description of Property: 1°CL 4o✓ L_D7 '7 <br /> r <br /> Section#: 2j� Town#: O N Range#: le, W Town of: 0 K o <br /> tO. m <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> G <br /> Tax ID#(1-5 digit number;found on tax statement): f 90/3 �• <br /> Proposed Use of Structure/Addition: ( I?,Q J7:.7p7' ro.... s. a ln�` op- Ry w <br /> Anticipated Start Date: / 4 UGI QC, 0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) c <br /> 9/$1t kW,42(6 7eiroPA�'Ts d <br /> Building Contracto_r`. Sewer Installer: <br /> H <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 theta prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z ry <br /> home additions,and bunkhouses.** ;e <br /> s Fee Rec: 6 5�`b' <br /> 8 <br /> Check#: 24<s� <br /> Date of staff site visit: ' �' _ Ry. s of site visit staff: z <br /> o <br /> APPROVED BY LAND SERVICES OFFICI i: r ik : -3(tea ° ! ( �� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a a ��-��-'�� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 41 <` r <br /> Transcendent: - Page 1 of 4 P, g o co c <br /> Laserflsche: - Burnett County,WI Land Use Application—Rev 6/2020 3. o c4 <br /> e 3 <br /> cn CD <br />