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LAND USE PERMIT APPLICATION— Burnett County, WI Cr ro ro <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 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 '9 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n R� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 < O <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 /> *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 /> CD <br /> Property Owner's Name: `J b"J� M l uuq- -1 del z <br /> I Q o <br /> Property Owner's Mailing Address: /bl-t V��1 CR)O6d�M►'� SS Z / o <br /> 0 <br /> Cit State Zip <br /> Property Site Address: Z92S _P�5 MID t hI�5 �—Tt2. A0 Le- W�E 54V3D ' <br /> Contact's Telephone Number: 414 303 S 0 o <br /> Contact's Email: 6 GNyk 1 °eA k . 60 C0-'rl o <br /> w <br /> rn <br /> Legal Description of Property: <br /> Section#: �y Town#:__N Range#: W Town of: <br /> 5' <br /> *Attach additional page if neededfor lengthy description OR attach a copy of <br /> the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number; found on tax statement): Z4 2 7 <br /> Proposed Use of Structure/Addition: .6+0 r a G((ai <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) 0 x <br /> Building Contractor:M a (r IL j tk5`- Sewer Installer: t7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONLNIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDCInspector 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.** Ab <br /> Fee Rec: LDS <br /> / o <br /> Check#: <br /> Date of staff site visit: �0 Initials of site visit staff:7 <br /> a- - <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF T <br /> )rnn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTo <br /> Transcendent: - Page I of 4 C=) <br /> Burnett County, WI Land Use Application—Rev 6/2020 <br /> Laserfische: - <br /> 3� <br />