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LAND USE PERMIT APPLICATION —Burnett County, WI E <br /> Applicant Complete All Sections Below This Line c cI CD o <br /> Permit Types and Fees:(Please,check appropriate boxes) Q. <br /> Dwelling/Principal Structure I$300' Addition/Alteration to Dwelling/Principal Structure ($200 I s, d n <br /> Structure atrUCtiire $3Commercial/IndustrialAddition/Alterati6n to Commercial/Industrial nuUStrial Structure $200 1 . v I L-dr- <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ` <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i y <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk iBunkhouse $250 I ��j <br /> Driveways)&Campground Structures $125 'WI State Statute 59.692(ly)Structures $350 I ° --\ <br /> Filling/Grading $150 Boathouse $500 <br /> i <br /> Six Month Camping Unit(One Per Year) $100 h (Permit Extension(l Year Extension-Allowed Once) I$100 <br /> *NOTE:After-the-fact permits <br /> (permit aquired 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. <br /> Property Owner's Name: -7-1:n C/ /)(4 in, ICD <br /> z <br /> Property Owner's Mailing Address: 2 o <br /> 0. <br /> / City State Zip <br /> Property Site Address: 9 / !D a u i .� c r- = <br /> 6.J' i. rn <br /> Contact's Telephone Number: <br /> p d /a 5'la. ti 9.34/ „...----->g <br /> o <br /> Contact's Email: til rid t x0 04 S Vi, ,G 0 I•yt_ d <br /> F <br /> Legal Description of Property: 42 `'j i Dui 5 d i <br /> N '-d <br /> Section#: a 6 Town#: 2 Q N Range#: / 6 W Town of: Mete, ,,L . r <br /> *Attach additional page if needed for lengthy description OR attach a copyc� the deed OR attach tax system properly page.* <br /> * • <br /> ae <br /> P K K Y P 7 Y P P ty'P K Y. <br /> Tax ID#(I-5 digit number;found on tax statement): / i 0 l .7 co I !) o. <br /> Proposed Use of Structure/Addition: <br /> P GOIe! ST®rc\5e % H H <br /> Anticipated Start Date: <br /> p /0/ 2 p llnnui("uhin;Commercial Business;Bedroom:Deck etc. o =' <br /> 64 <br /> Building Contractor: ill y a'ei-g Sewer installer: `i iH <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to r� <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes, manufactured z V <br /> ,...., <br /> home additions,and bunkhouses.** x <br /> eed to X l S/p7t ei 4,ertr ri✓eK or- <br /> re t„ve'A if 4 YuJy hi.3-(3c)11 • -3 Fee Rec:ffV— <br /> Check#: <br /> .W/57 <br /> Date of staff site visit:lO''i 5 °c0 Initial of ite visit staff: Y z <br /> APPROVED BY LAND SERVICES OFFICIAL: (frATE: V ��' gp�d.-G. c w <br /> Iiiiil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c w + <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °o o = <br /> Transcendent: - Page 1 of 403'< U <br /> Laserfische: Burnett County, WI Land Use Application —Rev 6/2020 Ifig <br /> L� J <br />