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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> :n <br /> r N <br /> Applicant Complete All Sections Below This Line 5 ce <br /> Permit Types and Fees:(Please,check appropriate boxes) `" ( l <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 _.� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `1: 0\ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 --- 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 .-1 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n , C___ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ,. <br /> Filling/Grading $150 Boathouse $500 r- <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> cn <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. t <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> co <br /> Property Owner's Name: V 2 ii--Ai f ft 1.s%L z <br /> Property Owner's Mailing Address: oZ 7 q 4, S ter-A A/ Ri • W Ji"Y ryj7J o <br /> V\ City State Zip <br /> Property Site Address: �/7►f�J6-7 <br /> n <br /> Contact's Telephone Number: 12-3-1q--12--3-1q (OO , o <br /> Contact's Email: 3 -.( j/204.-•._ (J �„'� ,c,r��� ,Q '� G d <br /> f <br /> Legal Description of Property: ovi 4-or6 At crf l'6 <br /> // `p,_i ' " bde*„6 ?9J <br /> N x <br /> Section#:„..7 Town#: *A/ N Range#: / W Town of: Sec/ __ <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): /8 7j' �. I , <br /> Proposed Use of Structure/Addition: JHC 0 CA <br /> Anticipated Start Date: °� <br /> p —/� app (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> J <br /> Building Contractor:de-Ass( v4S t,.vreS'i}Z Sewer Installer: f`ii 4 <br /> -3 <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 <br /> ANY construction taking place for any dwellings, dwelling additions manufactured homes, in nufacured z <br /> home additions,and bunkhouses.** .(2.0( ittA/toiLat,v%. <br /> lin <br /> ♦ x <br /> - Fee Rec: J5 ) <br /> I <br /> Check#: 53& <br /> 5-- <br /> j <br /> Date of staff site vis' / � � •als of site visit staff: z ; <br /> APPROVED BY LAND SERVICES OFFICIAL '- DATE: Y---;--) l < ligil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> i...) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' r...) <br /> lv <br /> Transcendent: - Page 1 of 4 o <br /> Laserfische: <br /> Burnett County, WI Land Use Application— Rev 6/2020 I �, <br /> m <br /> • o �� <br /> c, <br /> 3 <br />