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• LAND USE PERMIT APPLICATION - Burnett County, WI cr r <br /> b <br /> Applicant Complete All Sections Below This Line 5' o <br /> Permit Types and Fees:(Please,check appropriate boxes) ,:"A ry <br /> Dwelling/Principal Structure $300 )( Addition/Alteration to Dwelling/Principal Structure $200 m <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `�r_ <br /> its <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 S O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250I <br /> G] <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< n <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v.) <br /> *NOTE:After-the-fact permits(permit aqui red 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. co <br /> r <br /> ' Kr--GO( CK '4-- 01)1e/9 3SK�/ ,t" o <br /> Property Owner's Name: ` o3 <br /> Property Owner's Mailing Address: /A45 &7i-SO/l) 5P ,� 1 Obtil� 541V °C <br /> _ City State Zip b r <br /> Property Site Address: 5141Y)G 1 <br /> 7. <br /> U1 <br /> Contact's Telephone Number: $47 44&0 -43,9s <br /> CD <br /> Contact's Email: S'Ced5ka lig/1 arg /YIC.t 1 I. Co n� d <br /> Legal Description of Property: inn" v <br /> N b <br /> Section#: 13 Town#: 40 N Range#: /4 W Town of: Se-e'! <br /> 5' <br /> go <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property <br /> P <br /> 4 <br /> q <br /> Tax ID#(1-5 digit number; found on tax statement): / / 4,9 . <br /> Proposed Use of Structure/Addition: X 1(,a//7 M 0 h R_oc f 1 "' <br /> H <br /> Anticipated Start Date: ( "r d,®,Q (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: PI i C I L SO Nd Sewer Installer: 44)&r)G <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY J1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U-1 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to G <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured zCY <br /> home additions,andunkhouses.*� r ,/n � piô / fr/tk1 <br /> ,f--o llaii) <br /> x Fee Rec:-2-4 <br /> • Check#: 22)32_ <br /> lNL.-- <br /> o <br /> Date of staff site visit: ! O^ ice' DO Initials of sit(,.,e visit staff: z <br /> n o — <br /> IA <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ©^ �Q7 <br /> I; <br /> rz <br /> litil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF wr71 CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r.z C <br /> '< r::)o = <br /> Transcendent: - Page 1 of 4 3 a r <br /> Laserfische: Burnett County,WI Land Use Application —Rev 6/2020 3 C' <br /> o = <br /> a <br /> ` l <br />