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LAND USE PERMIT APPLICATION- Burnett County, WI a b <br /> N <br /> Applicant Complete All Sections Below This Line 6e <br /> Permit Types and Fees:(Please,check appropriate boxes) a' <br /> C7 <br /> Dwelling/Principal Structure $300 )( Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ' bO V <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r C. <br /> o ,. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> mit <br /> c0 . <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. p) a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. mit <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Ir <br /> /' 1 <br /> Property Owner's Name: C. /' l i fl (�/J�2 + /ivPi 4 ��LL y o <br /> Property Owner's Mailing Address: 6530 /v A L/ /Ls Pe 4 BST* w l 5-y8?3 $ ' , <br /> / y City ..State Zi <br /> Property Site Address: 6.5:3o /� a/►Sc 41-m7 kA• t $�`"�/2 1''v.-1 .6—y(Y93 =' n <br /> cn <br /> Contact's Telephone Number: '5" -2 g- 2.20,57 <br /> 0 <br /> Contact's Email: 0 a \ <br /> Legal Description of Property: S'W ,SW , C)( E ki e e)( IN 3 3O <br /> N ^o <br /> Section#:S'/`f Town#:TM/IN Range#1 g W W Town of: Me e--,c/O A/ 0 0' <br /> 0 <br /> bC5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax state/7 mment): I I i S" =. <br /> Proposed Use of Structure/Addition: O Mefx.2 4C ECA <br /> H H <br /> Anticipated Start Dated . (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) fx <br /> d <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q\ <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.**becvm ,, `_1 <br /> ,fy� 11 e ysi t t O-%e n ren\cdQ I x <br /> G 1\) C ktAmb i n5/1, 9 rn Nom e GAJ At SGn i �1 <br /> e I \\obi• SIO' rrAsit— <br /> in ralt_ <br /> 4 <br /> Fee Rec: 350— <br /> a <br /> Check#: �5 <br /> Date of staff site visit '�7�0--e c Initi of site visit staff: AV-- a <br /> LJ <br /> APPROVED BY LAND SERVICES OFFICIAL DAT < I y U{ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1 T F CS <br /> T g _ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> -' a DC Na <br /> Transcendent: - Page 1 of 4 o C <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 < . _ ��(' <br /> m <br /> D-3 <br />