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LAND USE PERMIT APPLICATION — Burnett County, WI a
<br /> Applicant Complete All Sections Below This Line c o
<br /> Permit Types and Fees:(Please,check appropriate boxes) °
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 .0
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<br /> Commercial/Industrial Structure _$300 Addition/Alteration to Commercial/Industrial Structure $200 , fin Ni
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,,Dc
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Ul q
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `�t
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<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° r
<br /> Filling/Grading $150 Boathouse $500 r—
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<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. �'
<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: Lou.At" Yecercr-, T z
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<br /> Property Owner's 14.41444g Address: %% % w . `Ae1Vow vex eNpr - c •
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<br /> j�Ci_ty State Zip $ `
<br /> Property.Srite Add ss 5 ‘ .4,C3 .R(X'Je 5ft PCfft M.I\1 w d
<br /> Contact's Telephone Number: )a'5-- c '&$ - (z4,% i'
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<br /> Contact's Email: LC uLri, e P.. \( - mak - C ysrt o
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<br /> Legal Description of Property: gilt:voYes' ©GLKS\ Lk k\
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<br /> Section#: Town#: N Range#: W Town of: Ooke.„kt.43r,cl 0
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<br /> CIC*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa e.*
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<br /> Tax ID#(1-5 digit number;found on tax statement): I ti 3 SS
<br /> Proposed Use of Structure/Addition: 5k,n( e j ._"N'S, Cchr►^ t_rO UIF'x ekc- "'
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<br /> Anticipated Start Date: 1 (Home/Cabin;Commercial B iness:Bedroom;Deck;etc.) I Fx
<br /> Building Contractor: V S4. tr-c--Li 'ti.:,c1 Sewer Installer: rZp,,,e_ V',e.e.8e_,8,
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<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 jig,permit is needed from them prior to y (J
<br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z
<br /> home additions, and bunkhouses.*" z �.
<br /> $ 5e0gt, Nttrrc + 19c• strvittet/i`caaukeo( loth, 1282020 or
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<br /> (oar ,t,, 14A+ -M bc, kSec� der- o- h�oifatb.
<br /> 2,rsi. x Fee Rec: l5
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<br /> Date of staff site visit: $�3/2OZa Initials of site visit staff: PCheck#: ,,,20;.-3-7miz
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<br /> APPROVED BY LAND SERVICES OFFICIAL DATE: ���/ 0 < J
<br /> UPON APPROVAL: APPLICA UST POST COPY OF el r
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<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT l 0
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<br /> Transcendent: Page 1 of 4 g m c na
<br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 M . .
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