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LAND USE PERMIT APPLICATION- Burnett County, WI <br /> Applicant Complete All Sections Below This Line 3' c o <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d JJ <br /> E �1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �c—�ny <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 X cl <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 16, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 ' < LL` <br /> Filling/Grading $150 Boathouse $500 g g ii: <br /> 1`` <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. , <br /> ip <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 7 <br /> Property Owner's Name: .S i/''" 44/e L‘+C <br /> �a o � <br /> z8 /Z y G y d goad' <br /> Property Owner's Mailing Address: ;ey�✓/z.Stas✓ A 64)r- sVeio $ <br /> / City State Zip <br /> Property Site Address: ii¢iek <br /> Contact's Telephone Number: S"/ Z 4 / -- 2y 9 / o <br /> Contact's Email: 5.-ee.ye"-, G, Al i//E d— ‘C-2-) Gvowl c.c.s- ti,/1 L d <br /> Legal Description of Property: c ,r 1 e_s- ,.( ©e e zee) g '7 VP'273 <br /> N <br /> Section#: Z3 Town#: 9'0 N Range#: /II W Town of: a4*Ai `AtN J/ <br /> . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g <br /> Tax ID#(1-5 digit number:found on tax statement): /3.- 7 <br /> Proposed Use of Structure/Addii /tion: /¢clD/ T x201/ T ®a7- i.b''/fie;:: � "' <br /> Anticipated Start Date: j 2 y 9O 7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) II o k <br /> 0 <br /> Building Contractor: tic-c,C Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMIMENTS/CONDITIONS ONLY Q <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.** <br /> Fee Rec:4 ic4 <br /> N Check#:[[.343 <br /> Date of staff site vi �� ()__C-). - Initials of site visit staff: Jk'kk---- >7 <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL:( i`r -DATE: 8--(71/ -�t < i,w " '""��-- <br /> ji <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° N <br /> 00rs.D (4 <br /> Transcendent: Page 1 of 4 m ,v <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 <br /> D <br /> 3 <br />