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LAND USE PERMIT APPLICATION-Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5' co o <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> r— <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,-:-s., 0 <br /> a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \c-v i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,) <br /> 51( <br /> .Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 "..._ <br /> 0 • <br /> Driveways/&Campground Structures <br /> $125 WI State Statute 59.692(1v)Structures $350 ° III <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 i <br /> a7 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g <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 /> IIP <br /> Property Owner's Name: Mar kJoAide r 1^c 5 6114 7- 2. z <br /> / o <br /> Property Owner's Mailing Address: 2 g I 0 ,\ c c 4..7 e / L a.i P1 r�A.tA 1M 01 <br /> City State Zip b ;IP <br /> Property Site Address:ze606 E.i rd-i is-loNri /e/I1 -"trot.i <br /> Contact's Telephone Number: - 5'57 c 7 O y cie.(U,) o <br /> Contact's Email: /'4 cn.rk 0 gvNaleriAto © rlJ'{mot,;(( co,v, 0 a <br /> : <br /> Legal Description of Property: i ,t-r'� Ar 6vJe FA/NI OA+ i p"-g c - 7 <br /> Section#: / b Town#: (/0 N Range#: /2/ W Town of: Sc.470 o °0 <br /> cm <br /> *Attach additional page if needed for lengthy description OR attacha copy of the deed OR attach tax system property page.* <br /> U. <br /> // <br /> Tax ID#(1-5 digit number;found on tax statement): /g l 6 Fi' <br /> Proposed Use of Structure/Addition: Go,rt-A.,` a— <br /> Anticipated Start Date: Mct�//,�C�t Ne, 22�Q 2! ome/Cabin;Commercial Business;Bedroom;Deck;etc.) y ' <br /> J N/^ d C7 <br /> Building Contractor: 5 c�!-� Sewer Installer: `7 <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,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** H-WQ,I11 r ' b i t t ±0.i\ <br /> 0� <br /> x Fee Rec: <br /> y Check#: JFd, <br /> `�\Z--- r <br /> Date of staff site visit: 9---C) l/�Qitials of ite visit staff: r <br /> APPROVED BY LAND SERVICES OFFICIAL: \/(Q-1\--------T—IVTE:T�d��o4� _.,T <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m.s �T <br /> 9 <br /> U JU <br /> Transcendent: - Page 1 of 4 W s t <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 '` a 1 <br /> I1 <br />