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• <br /> r <br /> LAND USE PERMIT APPLICATION—Burnett County, WI a It <br /> In N <br /> Applicant Complete All Sections Below This Line 3 o <br /> Penult Types and Fees:(Please,died(appropriate boxes) <br /> a " <br /> d <br /> Dwelling/Principai Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 !� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Sm <br /> t/ Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e a <br /> Filling/Grading $150 Boathouse $500 c D 3- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> tn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a)_ <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 /> s a <br /> Property Owner's Name: .Ta r{P4 R • AA P."1- '" c <br /> Property Owner's Mailing Address: Z9 a 2-1-1 va rf—ic4/ R%WA Q b; D42. / w:2 S'4*3c 1 <br /> City State Zip <br /> Property Site Address: SA II C En <br /> 3 <br /> Contact's Telephone Number: (c)Z -7_&' -7 L lo o <br /> c <br /> N <br /> > 7.( r a� <br /> Contact's Email: ('i q<"t- �'r►cl k CoGo ^'l G <br /> so <br /> Legal Description of Property: R' I R cm,K S / 1--n 1* 7-4 <br /> N "o <br /> Section#: Town#: N Range#: W Town of: 0 As k i-A%-i fl 0 <br /> *Attach additionalpage i needed or lengthydescription OR attach a copyofthe deed OR attach taxsystem propertypage.** 00 <br /> .f f P P 8 CI <br /> u <br /> Tax ID#(1-5 digit number,found on tax statement): (4 31 l 8 <br /> Proposed Use of Structure/Addition: Pc'LE. *PA"-at v-Lt 5'T't I E C kr' <br /> Anticipated Start Date: A P ie II- '7_.4. Z.1 (Home/Cabin Commercial Business,Bedroom;Deck etc.) 3 ' <br /> .�0R'>1Aa pre-E (3 . k k_D'elte d <br /> Building Contractor:'S .S Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -1 lit ,...:c. <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.** w <br /> ,--- F—0 1 101"/ (4.blvci)-kkea p(64- picoA <br /> x Fee Rec:__� Z <br /> y Check#: )339 <br /> Date of staff site visid0 ar ,,(7-}0\ Initi f site visit staff: d.,,, <br /> zI r—� <br /> o �� <br /> APPROVED BY LAND SERVICES OFFICIAL: r <br /> 3794;0 <nc <br /> t-- R <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF H 3 ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 w o <br /> Transcendent: - Page 1 of 4 A j <br /> Laserfische: - <br /> Burnett County,WI Land Use Application—Rev 6/2020 -iv � <br /> in <br /> i <br /> b <br />