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LAND USE PERMIT APPLICATION -Burnett County, WI g <br /> Applicant Complete All Sections Below This Line o c c <br /> Permit Types and Fees:(Please,check appropriate boxes) A �:.y°, F <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 k. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p - O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° 1 <br /> Filling/Grading $150 Boathouse $500o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. =�:I <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. - rs <br /> Property Owner's Name: vAO e 4(i[. 4-_5 o <br /> _ t <br /> Property Owner's Mailing Address: 2 0 i Y D iAcLC�r ) -46_,1M, �- 7 2 z °o 1 <br /> City State Zip .0 <br /> Property Site Address: 7g.(7 /J. E )S 4C E -go ,.6 51-F7L IN( V4(i>. J �' n -0 <br /> Contact's Telephone Number: (l'-51-r;0 - `7 3'74? <br /> Contact's Email: /Q d <br /> Legal Description of Property: 564- nifiehiP <br /> 2 <br /> en <br /> Section#: Town#: N Range#: W Town of: 'neer.c ' <br /> w <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPaSe.* <br /> P <br /> Tax ID#(1-5 digit number;found on tax statement): // 557--- <br /> Proposed Use of Structure/Addition: L- r u t,vG (fit,- t -j e --- - C 4 5.,A/ `1) <br /> Anticipated Start Date;[;-0i b 7.L7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:_1006 t-rk 'pp wit.e..4 au51 Sewer Installer: AID/'6 Al 5 y <br /> ! r-- <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.** �(�O �r,�M Po— ' L) je///I? IJOf 7z-„,,eedD' ,S <br /> g Fee Rec: ri° <br /> 4 Check#: ._34.2 <br /> A:5"--7---e- <br /> / <br /> Date of staff site visit: L "--7-Or- OlInitials of site visit staff: MY a �� - <br /> n <br /> APPROVED BY LAND SERVICES OFFICIAL: l: /o—?- < LI irEl <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a C W4 FA <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o dee <br /> oTranscendent: Page 1 of 4 w 4Zf <br /> Laserfische: Burnett County,WI Land Use Application—Rev 6/2020 mCD 'gal <br /> CI <br /> rn <br /> L� JJ <br />