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' LAND USE PERMIT APPLICATION—Burnett County, WI r, <br /> Applicant Complete All Sections Below This Line ° c o <br /> Permit Types and Fees:(Please,check appropriate boxes) 1 a (5 <br /> XDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �"� <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 eb <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G] ADriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 C. <br /> o • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ', <br /> *NOTE:After-the-factpermits w <br /> (permit squired 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 structure.,such as:pergolas,lands 'ping,etc. <br /> /7 --- o 2 <br /> Property Owner's Name: r'� , G / ' G� c(7 i J, 4.,:tt c .. i <br /> ‘ <br /> Property Owner's Mailing Address: i;? / —0 5 G I--` z (L) <br /> City tate ip -0 1 <br /> Property Site Address: / i, K/1 v" (,c L-(.— - n /J <br /> y • <br /> Contact's Telephone Number: 6' 3d2 . e 23 o _ P <br /> ro <br /> Contact's Email: /9i 1ika.ti a o 1. �.o p✓► o <br /> !�' f <br /> FD <br /> Legal Description of Property: /0+— T L5 1y1 V ta r. Q / 6.-n. C xt /D 1-i)Section#: � ,,/) �, 2 °Q <br /> 6 Town#: a�j ! N Range#: /4 W Town of•--T'_` <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 1 <br /> Tax ID#(1-5 digit number;found on tax statement): // 7 Cj/ F. <br /> Proposed Use of Structure/Addition: f/ i < i <br /> U�u ( n `ID <br /> Anticipated Start Date: (Ho /Cabin;Commercial Business;Bedroom;Deck;etc) o n, <br /> -�"/� Ii <br /> Building Contractor: O/1 Gr 1(( U Sewer Installer: f�� �/J �' -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> ! II <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.** <br /> a ot,i-d&&r shower-v-0 cc e u9 0(4-eine/ex] by <br /> Lots ' be_ eomb i 11 e,.3( b We v. I� toao . L1we(I ng To gC <br /> • Cow\Oe-Eeky on one 1cileckrcet <br /> Fee Rec:3 <br /> • t,Je..\k \Y1 (R U`��- be_ -75 /A-0 en OH'u/ VII\r �/ E7 Check#:a6g3 <br /> D - 0 �hT Lea S 7) f - C_'_ <br /> Date of staff site vis t t'i�""` �` Initials of e visit staff:il . `- - r <br /> q U �, r—_J l_.J <br /> APPROVED BY LAND SERVICES OFFICIAL: / — I -p103-v < N '�`— <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 'Eiji <br /> m E i G) <br /> _ 5 _ Ef[f 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _`-'- o <br /> Transcendent: - Page 1 of 4 nal•< o <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 < 0 j�,[0 <br /> 3 <br />