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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line to o <br /> Permit Types and Fees:(Please,check appropriate boxes) °� <br /> p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,•A q <br /> ADeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n- \ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e I <br /> Filling/Grading $150 Boathouse $500r- ,111) <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c ' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,5 ---\ <br /> *Items not listed above will be treated as accessory structures,such as:_pergolas,landscaping,etc. ‘ <br /> Property Owner's Name: 5 "' � 1 G e — l'. <br /> r o <br /> Property Owner's Mailing Address:-- .0/ t�J �� rico,7- - ' (J$ �Vt/ Sr761 <br /> o <br /> City State Zip <br /> Property Site Address: / �� G..GC 0( Poo/7 �%/ �✓� �y'�"t-, I = �� <br /> Contact's Telephone umber: 0-57 '7 y? — 76,2 L o c <br /> •0 CD <br /> Contact's Email// ',-1 r-i ? -4( C./©r, W ,-"*A_ e <br /> rD <br /> Legal Description of Property: C71 7 G$' i / p 9,7 dr G 0/fib 7:7 <br /> Town ,/ Rangef'f y o °� <br /> Section#:-(7'.)'? <br /> #�Y�v✓ N # !,� W Town of: L _ <br /> 5' <br /> cra <br /> - *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property <br /> p <br /> Tax ID#(1-5 digit number;found on tax statement JY? 9 F. <br /> Proposed Use of Structure/ ddition: fr 2'' "' <br /> Anticipated Start Date: // ---A - —,..--)c.), .i.) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) s X <br /> d <br /> Building Contractor:''/}' Cy,0,\c-17- r---. Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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.** Po <br /> g Fee Rec: /025z2 <br /> v) Check#: 3730 <br /> tri <br /> Date of staff site visit: /D T*--0-0-D-6 Initials of site visit staff: li." r <br /> $ ____.-- <br /> ^� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Iq' °D-CS <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> : OCD ti <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> r....1 <br /> O <br /> Transcendent: - Page 1 of 4 . a) <br /> Laserfische: - <br /> Burnett County,WI Land Use Application—Rev 6/2020 , ; �Jjj <br />