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LAND USE PERMIT APPLICATION— Burnett County, WIcr <br /> • cn <br /> Applicant Complete All Sections Below This Line = o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> co <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 /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �'\ ` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° ' <br /> Filling/Grading $150 Boathouse $500 o 1 ? <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 lK <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = <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. '!�9.� <br /> j�j ` % <br /> Property Owner's Name: �iK L 0, /2 �Z. q�j z ��, <br /> PO <br /> rJU _J. , I o 4,N <br /> Property Owner's Mailing Address: f' C�X c�l W e-), [ fr Gtr/. S9 93 o T <br /> P rtY 0?t 775 4LSLY 1Q City State Zip 3 Pro e Site Address: L,.rl�(Q Ta�Ve n � � <br /> Contact's Telephone Number: 8/3 90 y' 334,9 0 r] <br /> c <br /> Contact's Email: <br /> P F/= ix e v- 117 ® p rMl cl j / , co pi d <br /> I <br /> CD <br /> Legal Description of Property: .� <br /> Section#: 12, Town#: 39 N Range#: / , - W Town of: tie.t: /1/ 3 00 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number; found on tax statement): //3 g <br /> Proposed Use of Structure/Addition: CeLb/A) `r' <br /> Anticipated Start Date: s-1 .;?QZO (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f x <br /> Building Contractor: 5e L/= Sewer Installer: b J e R 0/c}I p L WI <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: s 0A <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 10 <br /> A.VY construction taking place for any dwellings, dwelling additions, manufactured homes, manufactured z <br /> home additions,and bunkhouses.** x <br /> Fee Rec: (,....Y:1's Check#: C7 ro <br /> r- <br /> )� cm <br /> Date of staff site visit: 1 3 ---„lo itials of site visit staff: z , <br /> APPROVED BY LAND SERVICES OFFICIAL: \t-N-X....). °`�� DATE:? , - r 6C)-(3 < ry--/ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF -' r 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = c o p° <br /> -6° _ ry C <br /> Transcendent: Page 1 of 4 n -,K <br /> r-,...) <br /> C <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 < <br /> 3 <br />