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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5' c o <br /> Permit Types and Fees:(Please,check appropriate boxes) n Cn <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 . <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 � \ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 tom+ O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 '� ° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 P <br /> X Filling/Grading $150 Boathouse $500 r IIII <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(1 Year Extension Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-factermits <br /> p (permit squired after construction has begun)may cost up to three times the normal fee. 1 ❑m <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: C Rift /11.4 e- <br /> ,--A) <br /> - ° z <br /> ,p o <br /> Property Owner's Mailing Address: 79.65 6Au.A!?`'/ ei 4 5 4 4) ()j 5 4/��7) °o <br /> 0. <br /> //�� �-�- City State Zip <br /> Property Site Address: l_ l-C Iv( / j4.(� z <br /> 6":1K <br /> Contact's Telephone Number: ) Z94— 8.5(} o N <br /> CD <br /> CD <br /> Contact's Email: a.Wen C.(e ee5 c(rr ri f'{/ • /1c T . <br /> w <br /> Legal Description of Property: 6 (,,) 5E ex W .15-5 ,SAS 4- EY� � V,q P I� <br /> Section#: g Town#: 38 N Range#: /6 W Town of: 5 r ct it1 o ,Q <br /> E. <br /> °C*Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page.* <br /> P <br /> 7-.' <br /> Tax ID#(1-5 digit number; found on tax statement): ?co /9 <br /> Proposed Use of Structure/Addition: cn <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) £ x <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY •3i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 2 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to G <br /> ANY construction taking place for any dwellings, dwelling additions, manufactured homes,manufactured Z <br /> home additions, and bunkhouses.** z <br /> F'ii •P03' Cul ver+-• o r G reer vo f-f x c�+e <br /> Fee Rec: /5�7�"—"� <br /> e Check#:2,251 <br /> Date of staff site visit: ' /41P ,)6 ,_ vv Init'als of site visit staff: v`Y > <br /> C <br /> n r- <br /> go <br /> APPROVED BY LAND SERVICES OFFICI• DATE:Y"-©`•� 7—OQ < , >. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 < N <br /> P <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° .= I <br /> -< S <br /> Transcendent: - Page 1 of 43 H <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 rn <br /> C <br /> e, <br /> a <br /> -, <br />