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r <br /> LAND USE PERMIT APPLICATION— Burnett County, WI . g <br /> cAPPlicant Complete All Sections Below This Line 0 o <br /> 0 , <br /> Permit Types and Fees:(Please,check appropriate boxes) °" <br /> d 'Cs <br /> - Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V,► <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `, ^ DQ <br /> A Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> E <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 LI <br /> LI <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 $) ��jj C <br /> Filling/Grading $150 Boathouse $500 r- <br /> 0 <br /> Six Month Camping Unit(One PerYear) $100 Permit Extension(l Year Extension-Allowed Once) $100 v k <br /> v) <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. t. p <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 /> r, 0 1 <br /> Property Owner's Name: PI i(416:4.e.( 2 A c. •o <br /> Property Owner's Mailing Address: 3 03 Z l (0 1:41- AveAt o•A6&Jt l dy� 3C`- 70- <br /> -i ` <br /> City State Zip $ <br /> Property Site Address: 34 ;<l 6-th lint A) )c4it bc`ry >J 1 5.--ti a-34.' 5' <br /> Contact's Telephone Number: I t S-7 et r et t j- 0cp <br /> a <br /> Contact's Email: Th I Le 7`7J et c. Z t e by Mfr' I I• `E'r'-t <br /> Legal Description of Property: �. <br /> N -u <br /> Section#: =$ Town#: 4( N Range#: %(11 W Town of: SG.) 1 S S _ b0 <br /> . <br /> "q <br /> *Attach additional page if needed for lengthy description OR attach a copy othe deed OR attach tax system propertyPage.* <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): 2 30 ? .,. Fi' <br /> Proposed Use of Structure/Addition: t`j..rArt e_ z <br /> Anticipated Start Date: it - 2.1 - ?e (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ox <br /> -6 <br /> Building Contractor: Sewer Installer: A/1 A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMINIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ^. W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from then:prior to D <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z 1P oQ <br /> home additions,and bunkhouses.** I • <br /> P* <br /> 0Ok- �-0 IV/UA 1 4C3)l*a4I or <br /> 5. Fee Rec:'/`� <br /> N Check#: 5/''')/ <br /> Date of staff site visit: 9 2--C3 Initials of site visit staff: 1�t '�i , z <br /> % <br /> 2-5 -a°a© x <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE• rs <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> c;,11-1—16 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> .00r <br /> Transcendent: - Page 1 of 4 'm S 1::g} <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 W <br />