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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5' o <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,f" <br /> tto <br /> Accessory Structure(Garage,Shed,etc.) $150 NA Addition/Alteration to Accessory Structure $150 O O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n - r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o (7 <br /> Filling/Grading $150 Boathouse $500 r- 4 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 II <br /> 11) <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. <br /> ro <br /> li ro '_ <br /> Property Owner's Name: rbeC4 VI 41 0 Y1 I Ci z p <br /> Property Owner's Mailing Address: S 9(5 �l,fs�l A Like._ 1Q. V"e 6S J c O F. C 7 g l3 0, <br /> City State Zip <br /> Property Site Address: 5 q J.yt e_ c4 <br /> Contact's Telephone Number: IS-- 5 O VcCOo <br /> CD <br /> a. <br /> Contact's Email: d ec,yi,hc,len l e6? C rop'' 1 ;CO,Y1 e <br /> Legal Description of Property: t' I. <br /> � `�t( c�• P !3_ '� ro <br /> 4 <br /> � w 0 . <br /> Section#: 1 Town#: 3 9 N Range#: I �.4� W Town of: (1 e e a1.0,i 0. <br /> ri <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property <br /> P <br /> Tax ID#(I-5 digit number; found on tax statement):�� 1 I (tq <br /> Proposed Use of Structure/A ditio : V'Cq f <br /> p �0-1f�--)-6 r <br /> Anticipated Start Date: c- ome/Cahn¢;Commercial Business;Bedroom;Deck;etc•. <br /> E, <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C1J <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.** x 1 z <br /> ctic <br /> l4ttlAsk 3-r <br /> z Fee Rec: 15-UP <br /> Check#:— <br /> .c,_,. <br /> Date of staff site visite'—1,'<<� Initis of site visit staff: KV z <br /> o <br /> cA <br /> APPROVED BY LAND SERVICES OFFICIAL:G : • 1 ATE:lQ 3— � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a CL <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m N <br /> r- cn 0 00 <br /> ^< 00 <br /> Transcendent: Page 1 of 4 m w a <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 6/2020 < 3 K ``� <br /> m <br /> v <br /> rna <br /> K <br />