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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line S c o <br /> Permit Types and Fees:(Please,check appropriate boxes) °- al <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d S <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Ci <br /> X. 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 /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 U C_- <br /> � a O <br /> Filling/Grading $150 Boathouse $500 S• 9 7 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ' 0). <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. rb <br /> iA <br /> j � r i <br /> Property Owner's Name: • ' c rt 5 Ji t.41-t" ° ° z a <br /> �:ice'- p <br /> Property Owner's Mailing Address: g 6/ u(4+n 5--) Ii c""' ,t' lb+7 - 7> b t I r-/ { :I E 1 K <br /> , <br /> City State Zip 0. <br /> Property Site Address: 6 f V S perki -Sb crf E 0/2-, Djli ibcip y t.(.;1 5e,-.5„,__ -c) <br /> / •< <br /> Contact's Telephone Number: .0 — 2 -55 — 07 l/1/ o c <br /> CD <br /> Contact's Email:J ori --4 int t' rl7 4 i i . e. L..'Ili <br /> Q d <br /> GO <br /> CD <br /> Legal Description of Property: <br /> it) <br /> N ro <br /> Section#: .. 3 Town#: VO N Range#: 7 W Town of: (A fl i D N 0 0° <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): 7 l= j. <br /> Proposed Use of Structure/Addition: CP--e€r 1 111 r,t a C- ADO )4 Rb i I(.3 Ad cn <br /> Anticipated Start Date: 2- ---- z.-:-D-7_ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> C7 <br /> Building Contractor: Sc )- Sewer Installer: <br /> y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (.1\ <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to �7 ? <br /> 4 rf►root aynret!or?tn/7nnn n/nr1):or ally 4wror/r1nv, ,U4 1)1111111 nn4rfrnnc nrnnrrtnrtrrr1,4 hnr11,P nrnnrrtnrtsirof Z' <br /> �� . v o - r r <br /> O Wtrit iivaiulvnJ,ants f/ii►tnnt/IKJGJ. PO <br /> Poi- -Fa r4- h C4 'on <br /> Fee Rec:415 u <br /> Check#: I?17K <br /> Date of staff site visi� �I 4 i 'also site visit staff: '/W------- <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: —�7 79C06 (—"--- '1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY ( = R© <br /> , Fa <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Transcendent: - Page 1 of 4K= o <br /> Laserfische: - Burnett County, WI Land Use Application–Rev 6/2020 L - ifiR <br />