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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' c N <br /> Perrhit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O 51'. <br /> ` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,- .7:: 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 vg. R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C� _I <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse <br /> $500 o 1 <br /> • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 P <br /> En r <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 1�� f ,,r <br /> Property Owner's Name: J`TO/iInTS A 1 h 0/v /) ° z <br /> JJ0 <br /> Property Owner's Mailing Address: t 2 rr <br /> 3 c-1 140)1 y A v. N . D A KD A1. ;NIN 5-572.e 0 es <br /> `� City State Zip <br /> Property Site Address: S ` 2 1 Crr R 0 u we B 5 rEg W i, <br /> 65I -7oz 46 H G _< <br /> Contact's Telephone Number: N <br /> 2. <br /> Contact's Email: I (�,InCJI.1. t t / ej M al . CO M <br /> v <br /> Legal Description of Property: 5F A T T14 HED St)R U;t V <br /> Section#: 23 Town#: �(� N Range#: W Town of: 1'�O N <br /> 0 00 <br /> E' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number;found on tax statement): 2 &f 968 <br /> Proposed Use of Structure/Addition: Gi U 1 P M eN r 6-7'b f A-G E <br /> Anticipated Start Date: 7A- ' 2.,0Z,( (Home/Cabin;Commercial Business;Bedroom;Deck;etc) o x <br /> -�^ a d <br /> Building Contractor:To o Be- b ETERM)NE(D Sewer Installer: //t} s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY II <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** z <br /> 10 fde 0 aJ/ reps evt6 ae Il�}1�- 20_OS� <br /> 0 /Vet * loe- U$el • NDr Ati oAan GlQlo%�T4,4 1 <br /> Fee Rec: L56L5b <br /> y Check#: 3683 <br /> Date of staff site visit: /3/00 I Initials of site visit staff: /7-- z <br /> 0047Z1 <br /> xAPPROVED BY LAND SERVICES OFFICIAL: DATE: < ^ <br /> 0. 0 U ud <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a ;W rn , <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °1 a cc <br /> Transcendent: - Page 1 of 4 np <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 6/2020 < <br /> aa <br />