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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5 cn o <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> d <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 <br /> r o`Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c5 <br /> l Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G'1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < lb <br /> Filling/Grading $150 Boathouse $500 r %, <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ,C,.' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 41 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: f Z...C:DSI0l ej_. d P2YI 9- 31<A/}f A l' z <br /> Property Owner's Mailing Address: ( 2 C CA o A 26 -:-.4 mi=l _y3Ci o o ri <br /> City State Zip - <br /> Property Site Address: Sfi P1 C S' n <br /> Contact's Telephone Number: 5 7 /2O .4 3D 8 o N <br /> c <br /> lik <br /> Contact's Email: c1'ed$kc/ 0 E`? cAPiC4l I. COMP) d <br /> v <br /> 3 Ilk <br /> Legal Description of Property: <br /> N ^o <br /> Section#: /.3 Town#: q0 N Range#: / 'f W Town of: 2 0-r% °_ °q <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): /79 t ' <br /> 9 T <br /> Proposed Use of Structure/Addition: Pc LC 6, VD <br /> Anticipated Start Date: ©V 010 0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> a e <br /> Building Contractor: Sewer Installer: <br /> -I <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 ..b <br /> ANY"construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z cs...31home additions, and bunkhouses.** <br /> $ 'Poke gam Kat 4a be wed 4r himuom I#ate;iciko kit. <br /> _. Fee Rec: <br /> Check#: �Z 5 <br /> /2' cr-4:'e <br /> Date of staff site visit: /f/2.O2.T. Initials of site visit staff: > ----- <br /> / / C l <br /> APPROVED BY LAND SERVICES OFFICIAL: L _/ / 'ATE: 9i//ZpZ,0 < r- <br /> yy w �i <br /> UPON APPROVAL: APPLICA ' • UST POST COPY OF a m W = G� <br /> '1 D <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o oIfifd <br /> '< :D C r-. <br /> a <br /> N <br /> Transcendent: Page 1 of 4 <br /> N <br /> Burnett County, WI Land Use Application—Rev 6/2020 z <br /> Laserfische: - rn <br /> o <br /> CA <br /> a <br /> 3 <br />