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LAND USE PERMIT APPLICATION— Burnett County, WI b <br /> a. c N <br /> Applicant Complete All Sections Below This Line o a o <br /> Permit Types and Fees:(Please,check appropriate boxes) 4 <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 v143 <br /> ��^'' <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 9\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 OQ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 . <br /> Filling/Grading $150 Boathouse $500 C. <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. z. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. aT <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. un <br /> Property Owner's Name: L istive-� 3 61 Fs; C z <br /> e;' <br /> Property Owner's Mailing Address: )OI() W 0 1 T Z e it/ I Id DR. r14 RI) IL 61/0g o o <br /> `� City State Zip -0 <br /> Property Site Address: 1 11 lt?.�1 t2.van ko IA d 5 j U°V` k'� 512312 <br /> `` <br /> Contact's Telephone Number: l l► 6'7243 <br /> o N <br /> • c <br /> CD <br /> Contact's Email: brcadi e- e(S o n-i .t.: , dvi v v (0, e <br /> Legal Description of Property: i--(-0 I 1 7/ 1 e IC©W E Ya 1�1� It t'.�vt. 170 V1-0 ( S .. <br /> N '-o <br /> Section#: C1 Town#: 3 CS N Range#: 16 W Town of: LA c oil ET o °° <br /> 5" <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): ' 02 .49Proposed Use of Structure/Addition: 1 v L 5 L' I`, <br /> Anticipated Start Date: Iv C,0 Z 0 LI (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) F x <br /> R,�vad .6rfV?S a 1 ti0 . . <br /> Building0 E3 <br /> Contractor: �� Sewer Installer: r- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 7\ k) <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to cp <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z ..0 <br /> home additions,and bunkhouses.** <br /> 0-CkitiACY\ <br /> N -\.- . -0 r Auvi\a-tA <br /> r. Fee Rec: <br /> Check#: 6.1q a S <br /> Date of staff site visit79 T <br /> �e2 �- 0 <br /> tials of site visit staff: Y — <br /> 7 <br /> 451(— <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ` <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF tg3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ":o <br /> Transcendent: - Page 1 of 4 o <br /> Laserfische: - Burnett County, WI Land Use Application— Rev 6/2020 _ <br />