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• <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line c o <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `G v 1 <br /> /ry ( Accessory Structure(Garage,Shed,etc.)2 1b6' Addition/Alteration to Accessory Structure $150 g <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 p <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .< ,` ip <br /> Filling/Grading $150 Boathouse $500 r vN <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up o ree Imes the normal (1 <br /> - . -- -. • ,an, ees. Z 25/c o t� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> r 9 <br /> Property Owner's Name: 0 OMR'L.,0 j A 6. (S q,0 0 A C.4C 'i‹. z cb <br /> Property Owner's Mailing Address: I a iP C,ii cx e R'�01 g 0 6 C 3 3 o o ^ <br /> U..)c3-.46 5 f..+�" / `f '- City S*ate Zip °' In <br /> r <br /> Property Site Address: <br /> 5' <br /> ill <br /> Contact's Telephone Number: '7(S "Cr 6C.- q/ a 7 0 <br /> c. 1 <br /> Contact's Email: ^p <br /> d <br /> Legal Description of Property: G G C I Li TN S ) 1 7 SW S cc) 6)6 Su) 18 <br /> Y4 o 0o <br /> Section#: Town#: N Range#: W Town of: l.,I Al C Y � <br /> 5 <br /> =. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O. <br /> Tax ID#(1-5 digit number;found on tax statement): 1 0(, 1-0 T <br /> Proposed Use of Structure/Addition: , 5 tax, A'(' d - }.e b c4 <br /> o <br /> Anticipated Start Date: (Homme/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> o C7 <br /> Building Contractor: Sewer Installer: <br /> -s .— <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 then prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** Pv <br /> 00.\ f 0-‘1\ a <br /> Fee Rec: <br /> 1_15- <br /> Check#: 3C ' <br /> rk\LDate of staff site visit/6 --7--- - 0 Initials of site visit staff: 2 <br /> 7. <br /> APPROVED BY LAND SERVICES OFFICI• I,. , ` 01 I :TE: /0 b `e, < r ^ <br /> UuU <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m 0 <br /> - 5m o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ca,= Nil <br /> Transcendent: - Page 1 of 4IT aK Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 < 3 lU <br /> R - <br /> a <br /> 1 <br />