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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' c o <br /> Permit Types and Fees:(Please,check appropriate boxes) n <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 � <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c(= <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C) —COp� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° & ,s <br /> Filling/Grading $150 Boathouse $500 c 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact ermits <br /> p (permit squired after construction has begun)may cost up to three times the normal fee. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. .Pa— <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: Yero <br /> �•-•,Jc .5 e- , V Q v'1 ►f'SIR Yl►rl `� -cl ° g r., . <br /> z <br /> Property Owner's Mailing Address: 3 ") / 5'th si. C1ecw- Lc\.kt. S 4/OV.3 I o <br /> `n� City State Zip •a <br /> Property Site Address: 8"6 a y Q/,,,:_,k /3?(\1 /,-.-t r / /.Jc nlivrL *- JJ' S LI s, 3 j <br /> J cA4 <br /> Contact's Telephone Number: 7/ S 6 L./ 9 9 !o o r, <br /> Contact's Email: F c., h e,nn hot(710.1 a. <br /> .t CO rt\ d <br /> Legal Description of Property: 0 1o► L k. 6tct - _`�c r-e s L! 9 i <br /> N ro <br /> Section#: Town#: N Range#: W Town of: ° 00 <br /> E. <br /> crq <br /> *Attach additional page ifneeded or lengthy description OR attach a copyofthe deed OR attach tax system property page.*P % /� SY Y P P tYPe p <br /> Tax ID#(1-5 digit number;found on tax statement): & a ss- -7 a <br /> Proposed Use of Structure/Ad ition: Pov'ck cA <br /> Anticipated Start Date: 7/c ._ / a 0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E x <br /> NI <br /> )1 Q <br /> Building Contractor: L � ' - S�txir J Sewer Installer: N► Y 1 -3 = u <br /> � Cc‘n� ` � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY \, su <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.** x <br /> ^,�,co <br /> Fee Rec: o�1 - <br /> Ay <br /> , Check#: 'b(( <br /> Date of staff site vi ' C/'� D ® Ini 'als of site visit staff: z <br /> I <br /> APPROVED BY LAND SERVICES OFFICI DATE:3—v L/'°Jo < <br /> ,.... <br /> ,,,, <br /> Ril <br /> ,,a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT (c)F" N iiiii <br /> o C N <br /> Transcendent: Page 1 of 4 pro = <br /> Burnett Count WI Land Use Application—Rev 6/2020 : ' `=, <br /> Laserfische: - Y' PP ., (D <br /> - L 2) <br />