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LAND USE PERMIT APPLICATION— Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line v c o <br /> Permit Types and Fees:(Please,check appropriate boxes) o. c• <br /> Dwelling/Principal Structure $300 X' Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> sa 00 <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 r` Fo <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< �� j� <br /> Filling/Grading $150 Boathouse $500 o ' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After the fact permits(permit squired after construction has begun)may cost up to three times the normal fee. 7 <br /> r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b r <br /> Property Owner's Name: �A,, rS 4".:+ / rl G-u c. ...,., ° z <br /> ,_1_, o b. <br /> pp <br /> Property Owner's Mailing Address: //,..?9 /V V !'A /)-'^), ,94,jvr/� M A g.5-30y g <br /> / City State Zip z r <br /> Property Site Address: 4'/ "'A ? G+ +a Ci r c,It 04 ij i,.rr �yip� '$'ys30 cn l� <br /> tall4 <br /> Contact's Telephone Number: � - 3 S 7 — y 5 Y <br /> o <br /> t <br /> • c <br /> Contact's Email: G 4 r +"3 L u��d y y 61 6,,,,,A i/ - 6,,,,id <br /> Legal Description of Property: &} 6 , /PA', b0L.A. f nd add + LJ5C' <br /> Y' U;i?I45 e� <br /> L <br /> Section#: 1/ Town#: N Range#: �� N tl <br /> g W Town of: A G: k-5�� <br /> � °0 0 <br /> *Attach additional page if needed for lengthy description OR attach-aa copy of the deed OR attach tax system property page.* Cr. <br /> Tax ID#(1-5 digit number;found on tax statement):stI ` q <br /> Proposed Use of Structure/Add' io : .A r- 'i ce' <br /> Anticipated Start Date: S� / 2 a (Home/Cabin;Commercial Business;Bedroom; ;etc.) <br /> ,-3 <br /> x <br /> ! /t Dec/4 ° d <br /> Building Contractor: /4)/4�t/ L_4.01 1�..., S 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 them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** :7 <br /> 31 (war. hat 4e be lied 410 hutwtat. Gia4•0o )'ort. <br /> id Sepftc 4bmk, Oct w # hot Qodt s ciliac, iwtwtcoti t t. <br /> Sion TA�'Ib Audi have a pe')1M�{'� i. Oaf. (0.4`,2024 Or c.i{,x,{1'Ot,�. 7 Fee Rec: oZl.�`O <br /> Will be issited. Check#: 8'�bfo <br /> Date of staff site visit: 44/j62.O Initials of site visit staff: > <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: : �^_-� <br /> 8�0/202e <br /> T ra <br /> UPON APPROVAL: APPLICA UST POST COPY OF c 11111 <br /> I--.. <br /> 0 <br /> r < 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N a) w Guy <br /> -< 00 <br /> Transcendent: Page 1 of 4 n w <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 ` 5' C' <br /> o <br />