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• <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a g <br /> b <br /> Applicant Complete All Sections Below This Line 5 o <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v.... <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ,x <br /> '� <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e <br /> ,... <br /> Filling/Grading g g $150 Boathouse $500 I 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 I <br /> En <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 /> Property Owner's Name: ri.,401-AV ifalk. ° z i <br /> Property Owner's iviailing Address: P.64 ,_-& ))z- &YQ�)ts6 � .5�/a o <br /> //®uCity StA.ate Zip <br /> Property Site Address: d (l pi-, el�j 10( - n <br /> Contact's Telephone Number: /5 o1 Oi zici o F <br /> Contact's Email: • Q. CL k ickAd eaz4p <br /> w <br /> Legal Description of Property:PC-t I v' Ctij, Lam—14- 3°140 iii- <br /> o ao <br /> Section#: Town#: N Range#: W Town of: % ' ' % A <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C <br /> Tax ID#(1-5 digit number; found on tax statement): f 8''( ,/ <br /> Proposed Use of Structure/Addition: Or'-‘46 5h. _ � <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ox <br /> " f � d <br /> Building Contractor: /�� -' Sewer Installer: /� ,-3 ~ <br /> Ar <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COtiL`1ENTS/CONDITIONS ONLY 1V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: s op <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to r <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z 4 i' <br /> home additions,and bunkhouses.** x -..' <br /> r <br /> >-. <br /> Fee Rec: /57)4) <br /> Check#: x$8/3 <br /> Date of staff site visit: ! -1-3 — -z-v Initials of site visit staff: ii+,. IAA-. <br /> Ii ' - i <br /> II <br /> APPROVED BY LAND SERVICES OFFICIAL: 1). / 1L DATE: 9"Z 3 -Zaow <br /> hit <br /> '3c. Cn tl v t! <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z n Nz N == <br /> Transcendent: - Page 1 of 4 w iv Q <br /> Laserfische: Burnett County, WI Land Use Application-Rev 6/2020 _ 11?i <br /> m L JJ <br /> Q <br /> i <br /> 3 <br />