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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> 0. <br /> Applicant Complete All Sections Below This LineCD° c <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Q <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> O <br /> 711- <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 J1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C) <br /> e, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e <br /> Filling/Grading $150 Boathouse $500 o QJ <br /> Six Month Camping Unit(One Per Year) $100 1 Permit Extension(lYear Extension-Allowed Once) 1$1001 �j <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. CD <br /> I <br /> Property Owner's Name: Kr IYfL( kQV► bUl a KOW +?fi o <br /> Property Owner's Mailing Address: b20 NOrhiSB o <br /> City State Zip <br /> Property Site Address: 2� �� �l s���{�/;�—U1NL( <br /> Contact's Telephone Number: US - 1--1 q - l 2 5"i 0 <br /> a. <br /> Contact's Email: [' �KILo� a/�' m�nt-F inet d <br /> n (Go V LOT 5) <br /> Legal Description of Property: Sc c 0 _1 h 40 I-t �4 LOT 2 C,W V 2 5 P 2 f,1 <br /> o v� <br /> Section#:� Town#:_ID _N Range m W Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* �' <br /> pg f f S Y P copy Y P P h'PS C7 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 42$ <br /> Proposed Use of Structure/Addition: o xq e, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) x <br /> o C7 <br /> Building Contractor: Sewer Installer:_bane, <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, in anitfaetured homes, nunutfcictitred z <br /> honte additions,and hunkhouses.** <br /> Fee Rec:� <br /> 0 <br /> Check#: W7g <br /> Date of staff site visit: d�Initia of site visit staff: z <br /> 0 <br /> .-1 , <br /> APPROVED BY LAND SERVICES OFFICIAL <br /> � r r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z N HU <br /> v= <br /> Pa e1of 4 c <br /> Transcendent: - g m "D <br /> Burnett County,WI Land Use Application—Rev 6/2020 ` o <br /> Laserfische: - m <br /> b <br />