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LAND USE PERMIT APPLICATION— Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line s' o <br /> Permit Types and Fees:(Please,check appropriate boxes) p <br /> , V <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure k$2�00d <br /> ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i9 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r• _ ► <br /> Six Month CampingPer Year �� <br /> Unit(One ) $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. 2 <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. -o <br /> -.Vt— <br /> g MO <br /> Property Owner's Name: K orq § N_ ' / -1-IttPrE r `✓ r-' <br /> is-ProPert Y Owner's Mailing Address: .gli4.7 IC I�� tt KCT) DAN guRy, to Sl-M a . <br /> ( City State Zip $ <br /> Property Site Address: = n <br /> Contact's Telephone Number: C-715-) 222-- (SY8 o ; „ - <br /> Contact's Email: `101 C SferC1 e S iii el O CI.l►- /00K , Cil im d V <br /> 0 v <br /> Legal Description of Property: gA1N bow LA($ (off I 3 <br /> o z. 00 <br /> / <br /> Section#: , Town#: /10 N Range#: /(0W Town of: 0A-KL}�, j) <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): 1 ti g o fm. <br /> Proposed Use of Structure/Addition: CovEmb tt 'K s ) v, <br /> Anticipated Start Date: o -� <br /> p 1 1-- "ZC2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> a <br /> Building Contractor: A•�� D t�l�� � S eGi1/4 $i Rixi)04Sewer Installer: ! v —3 <br /> AREA BELOW.TBIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> Ik <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 10, <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured Z <br /> home additions,and bunkhouses.** <br /> Fee Rec:p L `f. <br /> N Check#: _49., <br /> Date of staff site visit:/0"--d'/--- -00.6 Initials of site visit staff: V__" z <br /> o <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /0 --obs-D-¢::. <\\ 1`11 ^ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF woo o 0 <br /> „ ?.a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° N o GUU <br /> --< W a AI <br /> V a p <br /> Transcendent: Page 1 of 4 R a� Q <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 m c Ifiiil <br /> o <br /> a <br /> 4 <br />