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. LAND USE PERMIT APPLICATION— Burnett County, WI a b
<br /> Applicant Complete All Sections Below This Line 5 .o
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<br /> Permit Types and Fees:(Please,check appropriate boxes) r
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1:-_,
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c.2,........./\)
<br /> /Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 iO
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 `-P- E
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<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
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<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o
<br /> Filling/Grading $150 Boathouse $500 r v
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<br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100
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<br /> *NOTE:After-the-fact permits(permit aquired 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. ,
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<br /> Property Owner's Name: /).tom . �/c-L h --- --,s/e- �c S/< Z i
<br /> Property Owner's Mailing Address: l'{ / 33' a<,s 43'// ar,ft,5C 14ti Ssq,5-
<br /> ,,`` � ity State Zip
<br /> Property Site Address: 02 7/7 .e3- ,n Sa /�a,- 1 £L . S 1/c,- .'
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<br /> Contact's Telephone Number: \__?, CS-570 767 or ��a a - ios-s- I ,''s_.. o G
<br /> Contact's Email: -/-,..‘.t5�� •D VCS/�, 4r- t 0.
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<br /> Legal Description of Property: © 1 - OR 6 - 510 -/6-3/ - 5 QSJ Oo c/- D,9 3 ci G,o ,.
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<br /> Section#: It Town#: Sip N Range#: y 6 W Town of: C ..t(/I,•94,,/)
<br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPage.* ac
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<br /> Tax ID#(1-5 digit number;found on tax statement): ( 3 (6 6 `I-
<br /> Proposed Use of Structure/Addition: (, G, e
<br /> Anticipated Start Date: J. . , 24j R o 0 1 r (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H
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<br /> Building Contractor: //„,e),e:,',.< -' .5 - /4P-- Sewer Installer: /V6,1-
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY w
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: A
<br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to
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<br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z
<br /> home additions, ad bunkhous s.** 'I P
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<br /> FC 0 piam ei'el�d7r � N J FeeRec::(S V
<br /> .----t> l `7CC4 -. (1 S-j- b /0 ?^7- —Cl/6 S/C2 (of
<br /> 1I n* Check#: 1 l i 1
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<br /> Date of staff site visit: lb r- 00� Initials of site visit staff: ==„..
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<br /> APPROVED BY LAND SERVICES OFFICIAL: :/0-1q--(,)coo ti ,
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<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t< 1 g
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT „4., .1
<br /> Transcendent: - Page 1 of 4
<br /> Burnett County, WI Land Use Application—Rev 6/2020 m� .••- I
<br /> Laserfische: - PPrri 1-. :-*---
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