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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line a. • o <br /> Permit Types and Fees:(Please,check appropriate boxes) a V <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 • d w <br /> C- <br /> r <br /> c <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,_.. C1 <br /> ( Accessory Structure(Garage,Shed,etc.) '0-150 1 Addition/Alteration to Accessory Structure $150 .-- <br /> O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 11 4 <br /> Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 <br /> _ <br /> g <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° , <br /> Filling/Grading $150 Boathouse $500r • <br /> • <br /> o p <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 CI <br /> • <br /> v7 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 6' <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 /> ( � o <br /> Property Owner's Name: —.....ie es f-4 e•4--)3 e i z <br /> ` o <br /> Property Owner's Mailing Address: I S 0 -�' „S'* <br /> H <br /> '1 t <br /> S „Ai 4.: VVI T7 'L o `3 <br /> City_, State Zip <br /> Property Site Address: F 3_7\ 1-p v't Ps G h j2-3 .A.,/C b 5k-p illi J t-i'5 93 F v <br /> E <br /> Contact's Telephone Number: U J i- 303 - a .\ a ` • y <br /> o ,,, <br /> a <br /> Contact's Email: \\'tvM j iyvNke.1-\j C it C 4A4 d <br /> FO <br /> Legal Description of Property: 't Po,c L0-1-5 \ 4 1 ¶j\C c)c. 3 <br /> N -iv <br /> Section#: ?j ;' Town#: 0 N Range#: /7 W Town of: U A l'e Ill\.. °_5. °' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement):_ z 3 LI 75 Sel g <br /> Proposed Use of Structure/Addition: 6-e1 aait. _ r <br /> Anticipated Start Date: )1- z -Zo z:Q (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o• X <br /> a e- <br /> Building Contractor: S C\ Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY S <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.** <br /> —4A/d 740 4e us c-4/ 1 14 4144a14 446ii 7icc ,4 <br /> - $ 5trNq,re, w►usl- be c t- /e.ed 73 - � „ 1Li� <br /> re,alc� C.eiV\ / f/�� QS /�74. L��iXi'rs 9 �/(C )/{jam Gil�l,OS x Fee Rec:)�� <br /> 17 30 e- r / —OF—&k ay )o / v2 Check#: / <br /> ni <br /> Date of staff site visit: 1( �� zo ado Initials of site visit staff: <br /> ))7/ z o <br /> cn <br /> ni <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 11/72020 <FS c— <br /> UPON APPROVAL: AP ICANT MUST POST COPY OF a a OW <br /> 41 fini g 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4. ^ <br /> il <br /> Transcendent: - Page 1 of 4 c c COn iso <br /> Burnett County, WI Land Use Application—Rev 6/2020 < -0 3 "' <br /> Laserfische: - R a < <br /> a [ .tel <br /> R <br />