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• <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a b r <br /> - b <br /> Applicant Complete All Sections Below This Line 5 o <br /> Permit Types and Fees:(Please,check appropriate boxes) ° gl <br /> c. Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 g <br /> m <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -D <br /> 1.44 <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 a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> /X\ n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e . <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 /> c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. kp <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. $17 ice/ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. V <br /> ` r <br /> B <br /> Property Owner's Name: ( r'l ce t Deo ol-{i,t,i i i o <br /> Property Owner's Mailing Address: j5-/e a,z, le .3-1-70,tS£ WI t'n vt, i'11.ti. S 54-i(q o <br /> ity State Zip $ I <br /> Property Site Address: 55.9 6C I p 1/1 p1/61 PJ 1 1't )Ui/) t4' std' 5' <br /> i 6-61 <br /> Contact's Telephone Number: 12 `�S J <br /> ' �S 1'8? qh ,�, <br /> Q a i <br /> Contact's Email: Vt U t;IVA l€C4- C OVVI CAA /kJ il f d c% <br /> Legal Description of Property: Li" 5 es tA J 7Tc.9S , <br /> t o oo <br /> Section#: ec Town#: 40 N Range#: I.(p aI <br /> W Town of: G Ct <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tae system propertyPaoe.* ac <br /> P <br /> Tax ID#(1-5 digit number; found on tax statement):i <br /> Proposed Use of Structure/Addition: d y41.0. <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o k <br /> Buildinga <br /> Contractor: S , Sewer Installer: I i rt.' _ <br /> �ti�} l 0 t1 '�(}�K�' � � C;61�� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: P- U\ <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, manufacture z k ^(,, <br /> home additions,and 4 ``nkh.ouses.** ' .‘e l� Na� fD.J 2 . <br /> — > prek ©T' Ne,C�.� acc�" t �1 <br /> --V ase ((Q -O� be �`` P�i of --Vot uo ; 1 <br /> cy - 1J aI Q c)1'\ PC LaI1cQ Sert/t ceS ?o -e rP LoccAo►� <br /> of-'\-tt cPAStra- o r\ - 63vaq-t-�Q5 (-)-/ke' _ Fee Rec:- <br /> 9/.....-- <br /> Check#: 1�31 O <br /> Date of staff site visit: itials f site visit staff: > <br /> APPROVED BY LAND SERVICES OFFICIALX vi a 'Del .1 � o'� < _ i Ta- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '''-',, ro,d P is <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 6 ' gin <br /> ob. <br /> Transcendent: - Page 1 of 4 ( 2 <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 m - <br /> 4 `� <br /> N <br /> > 1 <br />