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LAND USE PERMIT APPLICATION— Burnett County, WI a ro r <br /> b <br /> rn Applicant Complete All Sections Below This Line 8 c o <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 pQ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> v Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> /C Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 L <br /> Filling/Grading $150 Boathouse $500 r ‘ <br /> Q <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 l' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = i <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. ' `lam <br /> ,. <br /> Property Owner's Name: r i ,,1. Ci az lk <br /> Property Owner's Mailing Address: 1V7 o'cZ `� ��n�ur� u3' o <br /> Cit State ZipIP <br /> Property Site Address: LQ� � �Dr�� � %� la. <br /> ; b <br /> Contact's Telephone Number: 1( 5 c6lJ 4- 1 t o� ���""" l� o <br /> c <br /> m <br /> Contact's Email: ' On �'v- s vt e <br /> Legal Description of Property: Let 3 07 of tellatoM. <br /> Section#: 00 Town#: up N Range#: � W Town of: k�,��/6 . °Q <br /> 5' <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach tax system property page.* uc <br /> Pg .f f g Y P Y P P tYP e p <br /> Tax ID#(1-5 digit number; found on tax statement): N9 L( <br /> -,,. <br /> Proposed Use of Structure/ ddit' n: /�S f cJ cn <br /> Anticipated Start Date: "s) l 1 z/)Z O (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) E x <br /> 777: <br /> Building Contractorr�(Y)1 11 e y, Sewer Installer: <br /> -i <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 then prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** <br /> 71t.s , ,,A Aft- e--- " P'7741 . <br /> Fee Rec: ,�: <br /> . c.„., Check#: - �'-"`' <br /> frtY <br /> Date of staff site visit: / als of site visi staff: > 2 ��, 7. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ? Zo 70 ZO < - <br /> / I-; .0 5 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> :< a <br /> Transcendent: - Page 1 of 4 7 7' = c' < <br /> fl <br /> Laserfische: - <br /> Burnett County, WI Land Use Application— Rev 6/2020 < j <br /> Lc -- <br /> 3 <br />