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LAND USE PERMIT APPLICATION— Burnett County, WI a O. b <br /> Applicant Complete All Sections Below This Line z. <br /> c o <br /> a r <br /> Permit Types and Fees:(Please,check appropriate boxes) ar by <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structuce $200 d `^ <br /> - <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> :: <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Acc- sory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I R, <br /> tairs/Patio/Retaining Wall/Sidewalk /91.5 Bunkhouse $250 r <- N <br /> 11�X Driveways/&Campground Structures . 125- WI State Statute 59.692(ly)Structures $350 5 <br /> 1. ') .4 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CI' ?-- <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee._ 0 <br /> -*Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 1( q \,.e11-{\\U , <br /> Z r <br /> (� <br /> Property Owner's Mailing—Address: al() N• PO 1 ttU o <br /> D l q Li ' PO('n$ ►--G:. Ret W�S r(- StateCity Zip <br /> PropertySite Address: Sy q 3 r. n <br /> Contact's Telephone Number: S0 )- jot 1-O I `"1 1 0 c <br /> G <br /> o <br /> Contact's Email: A"\3`U . 1't�� <br /> �! fOlp 0...1-lc • C�(Yd <br /> Legal Description of Property: \—Ok <br /> 1 C..%rart �L}4( , V4 @qc-- - bu,t ow s-a7a lut <br /> 0 oa <br /> Section#:Q 7 Town#: l..{0 N Range#: I S W Town of: 30,CtSur\ <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy� of the deed OR attach tax system property page.* o <br /> 72. <br /> Tax ID#(1-5 digit number;found on tax statement):V''d \ <br /> Proposed Use of Structure/Addition: cf' <br /> o w <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> o G <br /> Building Contractor: Sewer Installer: <br /> -3 <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.** 1 <br /> 1 <br /> Fee Rec:3$1,5C <br /> y Check#••5438' <br /> [AK__ 0 <br /> ,,a <br /> Date of staff site visit: Ini a is of site visit staff: Z <br /> 0 <br /> „„„ <br /> APPROVED BY LAND SERVICES OFFICIAL t""" DATE: O .;'e�e- n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <co = C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z o o �' <br /> Transcendent: - Page 1 of 4 rn o <br /> Laserfische: - Burnett County, WI Land Use Application— Rev 6/2020 m c <br /> o �- <br /> Z <br />