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LAND USE PERMIT APPLICATION — Burnett County, WI a i <br /> N' F N <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <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 �•� I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,h+\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o ---k <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 /> J ' <br /> ii <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 /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 5 t <br /> 'T <br /> Property Owner's Name:Tin., I h y (=Trill/y / S� �t n4-4 O - G3-h'r`tr-` o II <br /> -n <br /> // <br /> Property Owner's Mailing Address: t0 15 3 Co 0nTy le-04d C be4418 ugy Lar- 548 3 v °o <br /> City State Zip io <br /> Property Site Address: l .�uTh <br /> R 53 Cn-1 c ' G INA-A.)60-1 t,,� <br /> A- 60-1 g 5,43 0 .' c <br /> Contact's Telephone Number: ( S — a (. 4- 73/'S o <br /> egCDa <br /> Contact's Email: I '0~51-1, °' C-e�v^Yt"GI . n.4..-'� .. <br /> r <br /> Legal Description of Property: S w sit) e K S eA 1 <br /> N ro G <br /> Section#: Z Town#: /0 N Range#: I ( W Town of: C'AC(-A Nb 00'' F. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g <br /> ( 7, <br /> Tax ID#(1-5 digit number;found on tax statement): 13 5a c' <br /> Proposed Use of Structure/Addition: 0 4 Z/-a 1 .e —I —i <br /> Anticipated Start Date: 8//O/L1, ..c (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o �e <br /> Building Contractor: Sewer Installer: ,\- lA ,-3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: T <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.** <br /> Y1 &we,,,gt vos4 lb (Pt tAla 4r k � kektoi4-0:i'loI4. <br /> UU <br /> Fee Rec: I A)—CJ° <br /> m <br /> Check#:(5 <br /> M <br /> Date of staff site visit: 00026 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /io/2o2o <br /> UPON APPROVAL: APPLICA MUST POST COPY OF a .L <br /> RI- <br /> , <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> , t 0 0 C <br /> � � r„ <br /> Transcendent: - Page 1 of 4 n 7'. c.3 C <br /> Burnett County, WI Land Use Application—Rev 6/2020 < d r' <br /> Laserfische: - o ;k_ ..__ <br /> fi4 <br />