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r <br /> • LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line = o <br /> P <br /> er Types and Fees:(Please,check appropriate boxes)7a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a. <br /> 11 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 (� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �v <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 $) <br /> Filling/Grading $150 Boathouse $500 r• <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a , <br /> Rs <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 /> l v r i <br /> Property Owner's Name: bCI,4 rie �iuderso a o <br /> i <br /> d nn :j <br /> Property Owner's Mailing Address: 3.09�i JTiy & e IV. S'i ,'iar to .5510fl $ <br /> `` ;� <br /> ;tCity State Zip <br /> p�� <br /> Property Site Address: O7.S E4 Si Yetki,t 'wr l�((:.' / 1)C¢/y1 city Lea, E. n 0, <br /> E <br /> Contact's Telephone Number: 71(5 S-80-080 <br /> O in <br /> l • a. <br /> Contact's Email: 1 e r-ec t,S Mown/ICly g *IAA 1,c cin d <br /> Legal Description of Property: S rc .(cit uy N ro .. <br /> Section#: -7 Town#: CIO N Range#: C6 W Town of: (2okl4 c 0° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> Tax ID#(1-5 digit number;found on tax statement): I i a3 9' �. <br /> Proposed Use of Structure/Addition: C-Ai eV cA <br /> Anticipated Start Date: C?--4--X, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor:`he961uutr- ebasT Xivc. Sewer Installer: Eltt"5.t -i <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 �l <br /> /LAY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured Z <br /> home additions, and bunkhouses.** <br /> Fee Rec$3tb <br /> y Check#: b`j <br /> v <br /> ciia <br /> Date of staff site site r ---a.6aCini s of site visit staff: RV z <br /> APPROVED BY LAND SERVICES OFFICIAL - DATE: "— /"— � ~ ��=j <br /> rmi I3) 15il7 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ; a co c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,' om <br /> 0 CVNil <br /> -G U O CD C _N O <br /> Transcendent: Page 1 of 4 n N <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 < g c. <br /> m cc, Nll <br /> a <br />