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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c o <br /> PP P a <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure i $200 -4) <br /> /Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n \ IIIIII <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° p <br /> Filling/Grading $150 Boathouse $500 r-- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 K1 <br /> , <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. p <br /> t— Bo . <br /> Property Owner's Name: P1-teVD Y\Ow NCO% gtc%s%`a o <br /> r <br /> Property Ovaie.'s Mailing Address: '2. i-156S Yeti+ exi Wet.-)s4e✓ W( Sl�ci 3 o r <br /> ,� City State Zip b <br /> Property Site Address: 2.15O% F <br /> Pra4. -OCkc b}-Q/r vv t Sy 8.13 �' n <br /> Contact's Telephone Number: '�J 1-'"1 S3' 2.2 o • <br /> a V, <br /> Contact's Email: b oSsO(YZSI®) 1p 4(1r1U11 • (vpir1 o <br /> IP <br /> CD b <br /> Legal Description of Property: 1-'0 4. 'I- csm V 4 f 7.,2jIN) �/ (i I) i <br /> N 'v <br /> Section#: 3`i Town#:T 4)14 N Range 4i 5 fi W Town of: i f}(.r Sop 5 °' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> P.. <br /> >~. <br /> Tax ID#(1-5 digit number;found on tax statement): 5 Cj 5 2 <br /> Proposed Use of Structure/Addition: <br /> pay i n5 Clara c{L,.. ) c4 <br /> Jo <br /> Anticipated Start Date:0(.4 (Ho, /Cabin;t onimercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: ) • taut-( Go IGo�YM Sewer Installer: N4c `5h <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y v ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V 1 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to �j <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** 1 ,{-- <br /> ___---, tit,--t- FOC V u &I 4-Qkb `6A <br /> Fee Rec: 15 O <br /> i Check#: ., <br /> Date of staff site visit: 9"--C93)(.--- �Oa`dlnitials of site visit staff: AY-- a <br /> APPROVED BY LAND SERVICES OFFICIAL:f DATE: ?-.2-3 i !.. <br /> rn co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° N 0 <br /> vc <br /> . ro <br /> Transcendent: - Page 1 of 4 n Co CD G 13 3 <br /> Laserfische: <br /> Burnett County, WI Land Use Application - Rev 6/2020 < 3 <br /> m <br /> _, .. <br /> 4 <br />