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LAND USE PERMIT APPLICATION — Burnett County, WI 2 g r <br /> Applicant Complete All Sections Below This Line �' o <br /> Permit Types and Fees:(Please,check appropriate boxes) a r5` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> 3,3 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C <br /> n N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 ` <br /> c <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. z <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> Property Owner's Name: 1l 1-143}U\.b 4 p] 4 N S o <br /> Property Owner's Mailing Address: 2:7-712- T3 4$p J ND Vaal-sit IN l 4'`$'893 ', • <br /> City State Zip - <br /> Property Site Address: E- E. n , <br /> Contact's Telephone Number: `1 iS lei\ an:3 o c <br /> AA�,,A a <br /> �j <br /> Contact's Email: Pa(4 4--e 1i1<-I NSC11'l y -- W'/, C <br /> .. <br /> Legal Description of Property: AN,% 4o /k t.E <br /> Section#: 2-5 Town#: 40 N Range#: 'i' W Town of: O y. rum <br /> o ao <br /> F <br /> ` <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system roperty pae.* Ci. <br /> 4- <br /> Tax <br /> Tax ID#(1-5 digit number;found on tax statement): 03674- <br /> a. <br /> Proposed Use of Structure/Addition: afi L-14ckc v) <br /> Anticipated Start Date: c ipr (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: , 1 Sewer Installer: PIA O <br /> -s <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 t .t, <br /> home additions,and bunkhouses.** <br /> M Ginty, Kai 46 IX (Asa .Or kw lbrWa K . <br /> adisk ittee . wwaf lot vewtoved o✓ a pcvw.i+ wi,�uf 1st.swUwkv l a J 2o2be -� .'i( �az <br /> // x Fee Rec. <br /> Check#: .211V <br /> Date of staff site visit: 30OAD2S • Initials of site visit staff: <br /> 65°P ri <br /> APPROVED BY LAND SERVICES OFFICI• a - DATE: 00/2o2'b n 1 hl <br /> UPON APPROVAL: APPLICA UST POST COPY OF '_ ' <br /> 0 to <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT `� <br /> Transcendent: - Page 1 of 4 1 }< <br /> Laserfische: - <br /> I c------j <br /> County, WI Land Use Application—Rev 6/2020 =j <br /> • <br /> a; <br /> x <br /> -d <br />