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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI 2 b <br /> Applicant Complete All Sections Below This Line a. <br /> o <br /> o , <br /> Permit Types and Fees:(Please,check appropriate boxes) (f <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 D <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W`\ 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(1v)Structures $350 . O <br /> Filling/Grading $150 Boathouse $500 <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 34 / <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. z <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: RD\41-h d. (3 I-4_,P°`Q -To A) z <br /> hYt ' Iv. <br /> Property Owner's Mailing Address: 1,'"? 5 "III 0 �S Ay �`, ' o <br /> IP <br /> City State Zip $ <br /> Property Site Address: y yv1 E <br /> Contact's Telephone Number: 7 t 5 2O 6—LI q 6 11 <br /> o N <br /> c <br /> 0 <br /> Contact's Email: 4J Al 1-`1-o�F Gm pf i L. C&vn o <br /> d <br /> Legal Description of Property: <br /> N <br /> 00 <br /> Section#: Town#: r-[0 N Range#: 1 W Town of: �P 4S Oki C <br /> 5' <br /> aG. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): ) r 60 / <br /> Proposed Use of Structure/Addition: "A-•._' 'fec0 - 96-a <br /> Anticipated Start Date: pn ,1/40 —(.. .,z p (Home/C'ahin;Commercial Business;Bedroom;Deck;etc.) H <br /> Ex <br /> o 5 <br /> Building Contractor: Sewer Installer: <br /> H <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 UI)('Inspector to determine if a permit is needed.from them prior toCI <br /> A;\'Y construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z d <br /> home c dditions,and bunkhouses.** 41:9 <br /> 6 .---o (0 kk\iDi y14 Cik'r p(0-i--- p tan <br /> lc -r sL 1 s bad- ,,�>, <br /> r x Fee Rec: 1 <br /> .� � � <br /> Check#: <br /> 14.....„, 8_ mDate of staff site visit: Ct /�a9 I itia ofsite visit staff: z <br /> a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:? J < <br /> F.)- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '. Q n G� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° m <br /> Transcendent: Page 1 of 4rrio o w <br /> Laserfische: Burnett County, WI Land Use Application—Rev 6/2020 o m. ro G <br /> 3 C <br /> o e, 11 <br /> a <br />