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LAND USE PERMIT APPLICATION— Burnett County, WI cr <br /> b <br /> Applicant Complete All Sections Below This Line c o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <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 \ <br /> •da ory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 (" g <br /> ap•tairs/Patio/Retaining Wall/Sidewalk rege Bunkhouse $250 n <br /> eways/&Campground Structures -$725- WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r 1 <br /> 0 <br /> Six Month CampinUnit .- •- - is •- ' _ .tension-All wed Once) $100 d <br /> IDD <br /> * OTE: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. <br /> * -.. .• ' -. ..ove •- -• -• • accessory structures,such as:pergolas,landscaping,etc. <br /> y� r -• ' <br /> Property Owner's Name: _>(, iv._ P k \?'-k 5..;-+2',-t, ° z I. <br /> Property Owner's MailingAddress: a Ciii __ o 1 <br /> P rtY l� C) �C( �d � ��11'b�t � � � ��$3L7 0 <br /> City State Zip .7 '' <br /> Property Site Address: )(A o CCC.- ?..,.pc- d-1 p �DG-v\Bu.A2-.t i vw, st-vg 3 <br /> Contact's Telephone Number:: 1 - 61 - 1 O 1 o_ <br /> Contact's Email: a <br /> car c�,,,� e �„dl �.,� u R-S P 9 w� �'>u o <br /> co <br /> Legal Description of Property: gG• I t<sk&, (-e,.- .k LS-' / G5/1/ 1107 1 <br /> �C 00 <br /> Section#:_2... Town#: / O N Range#: / , W Town of:_e /a ac/ 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* E.d <br /> H. <br /> Tax ID#(1-5 digit number; found on tax statement): 33-3?7 <br /> Proposed Use of Structure/Addition: i>?..C o, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> k d <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r` <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 /> — This �{ .+c-i-it / ac/ ?i1 adZY-f`otit i s fess I-A a/4 ?S7o <br /> ex fewsioH so (/— cq✓" be. c //oriea/ P e.r 3D-<o77, <br /> Fee Rec:l7.56 <br /> N Check#:1O(3. <br /> 7� o <br /> Date of staff site visit: I - t �iE/ 0 Mit' site visit staff: / r a <br /> Z. <br /> OF c <br /> rr, C3 <br /> APPROVED BY LAND SERVICES : FICIAL: Z Z WZil DATE: /2744,7e E <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ,o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' ; <br /> c ns �' <br /> Transcendent: Page 1 of 4 m <br /> 4 <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020TB <br /> LJ <br />