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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 cn o <br /> a. <br /> • Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> It/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 <br /> G" <br /> •Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> 01 <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 1 " <br /> v <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. <br /> I /J <br /> Property Owner's Name: Qr'�W ais /4/tily� Ii✓?G i5 oz <br /> Property Owner's Mailing Address: //—70( iEe tit I&' oC/ f ky o sir tor sort? g <br /> City State Zip <br /> Is'Property Site Address: 0 -, A I. .10 . .. S �� A 'o' <br /> Contact's Telephone Number: .7r."-- ..St 2 , /100 o y <br /> R. <br /> Contact's Email: i C- u i , M , »ft/A i L„ Gie til eleyild <br /> • <br /> Legal Description of Property: ar kheAkel 'Z/k L.)7 Oty� <br /> � <br /> Section#:SZ 0 Town#: N Range#: !( W Town of: 11/(e-64,0 I� o a__. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properlyPage.* tl' <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): / 2- 77 �' <br /> Proposed Use of Structure/A `� <br /> it' n: iA1eKJ <br /> Anticipated Start Date: ?/i/ v (Home/Gobi ,Commercial Business;Bedroom;Deck;etc.) x <br /> o <br /> Building Contractor: Self—1'F Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 3 c-- <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 .•.1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** %: <br /> 1\ ta1 _ rW�QtA ( �to�1.16 <br /> 00 <br /> Fee Rec:f15O— <br /> 4 Check#: ot q 01ci <br /> o <br /> Date of staff site visit:_9' I.;--D ,'tials of site visit staff: R\ <br /> l(.----- z_ "' ` <br /> APPROVED BY LAND SERVICES OFFICI• DATE f ✓�0� < `r ��� <br /> I a I �f.4 is tf <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c4 '` <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °,a i — u <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 �� <br /> d <br />