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LAND USE PERMIT APPLICATION—Burnett County, WI a `° r
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<br /> Applicant Complete All Sections Below This Line
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<br /> Permit Types and Fees:(Please,check appropriate boxes) > °d A
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ?; ( ,
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c/"
<br /> p,Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W) 0
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ei ,oma,
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .-.1
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350g.,
<br /> Filling/Grading $150 Boathouse $500 r o S
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<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee.
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees.
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.
<br /> Property Owner's Name: 7/20f ,(/'u-5$"�. o y
<br /> Property Owner's Mailing Address: 7 a �,9��,0f�,�E? ,�t �
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<br /> /� City State Zip .o
<br /> Property Site Address:a s 3 C,� r,,,,.�,,�f 4.4,4 .) 4.4.h</c -- &t . e9 `' n
<br /> Contact's Telephone Number:6�� - 33--1 -'9Y'/
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<br /> 74-,,,,--„....,27 G D„,i¢r`l, 'irL a
<br /> Contact's Email: o
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<br /> Legal Description of Property:D7.0 a8--,, •yp ./'f 14, 'y /9cDo 0 . ®/3 e'>e e ,/ N '-d
<br /> Section#: It , Town#:7® N Range#:/Qf'y W Town of: .le, °
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<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* tj
<br /> Tax ID#(1-5 digit number; found on tax statement): /.462/ef2c;) 0.
<br /> Proposed Use of Structure/Addition: c'A,p I "'
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<br /> Anticipated Start Date: e' ,ex, a o
<br /> p as, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d
<br /> Building Contractor: .5(0 ,1 $ - Pt,e-• go , t.t Sewer Installer:
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<br /> AREA BELOW THIS LINE FOR AND SE S 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
<br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured 'z
<br /> home additions,and bunkhouses.** x
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<br /> z Fee Rec:
<br /> Check#: ��.63
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<br /> Date of staff site visit: Init' sof site visit staff: z
<br /> c,Via, ...APPROVED BY LAND SERVICES OFFICIAL:1 DATE: b IPA., F) ���
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<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a a
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° 3 N��
<br /> Transcendent: - Page 1 of 40
<br /> Laserfische: Burnett County,WI Land Use Application—Rev 6/2020 m 3 Q
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