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• <br /> LAND USE PERMIT APPLICATION— Burnett County, WIcr <br /> -▪ ti <br /> Applicant Complete All Sections Below This Line c. c..-.. - . o <br /> Permit Types and Fees:(Please,check appropriate boxes) l <br /> ,.1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 V`r <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> /sl <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I <br /> ?c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 U/ <br /> riveways/&Campground Structures0$12.5-VWI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r 0 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> ,..11, <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. CO <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 /> Property Owner's Name: ��u k, C�5►�V �� , ° o � <br /> Property Owner's Mailing Address: 3 1 5 Co_ 2(�� A . `AJe( 1 yt. ✓TU��o <br /> City State Zip <br /> Property Site Address: :i <br /> �� <br /> .. <br /> Contact's Telephone Number: �t'S %Go— 3g6 o <br /> Contact's Email: (V/V` v:-t, 0 <br /> Legal Description of Property: <br /> Gam- / 6- v'u Pi, .,85 <br /> Section#: 23 Town#: Yo N Range#: /,� W Town of: JgGle......5o41 _ 00 <br /> q`*Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tar system propertyPage.* <br /> CI. <br /> Tax ID#(1-5 digit number; found on tax statement): .3/g' 9 <br /> Proposed Use of Structure/Addition: Dil-Gk c, <br /> Anticipated Start Date: 5f)y%7 20 z,1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) TV - x <br /> Building Contractor: Sewer Installer: 1 <br /> ..3 k_ _,,,,, <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 011 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z O ,` <br /> home additions,and bunkhouses.** a <br /> -FA ,`s u Ad •7/-0,1y Q', � v �ri ie.xpyi4si©at , <br /> Dem. c--criA-f e.x/d wi 0re. ±t1 ave ( 3 <br /> ie_ dial eJ/i ityC, +p5 y l'pj �0/p r�;moi.7["O-' Pc <br /> 7`1� <br /> 7 • <br /> � Do <br /> Fee Rec: i ZS <br /> U Check#: (17V <br /> / 7� o <br /> Date of staff site visit: 1� / ���" ��QJ <br /> ttt Initials of site visit staff: : z <br /> r ^ <br /> p rr z a UUU <br /> 2 10 * <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / < a g <br /> _Fc.- ----- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF = �2 _ OWSIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 �h N <br /> N Q <br /> Transcendent: - Page 1 of 4 a OM <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 n <br /> L�JJ <br /> cA <br /> K <br />