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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o' c <br /> Permit Types and Fees:(Please,check appropriate boxes) It <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 . OQ <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ` <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< • <br /> Filling/Grading $150 Boathouse $500 C- %) <br /> a <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ��^^ r - 066 <br /> Property Owner's Name: err 1%«- AftS6A /��►��j• ��r,� 7..- <br /> • <br /> Property Owner's Mailing Address: ZOO ( /42/44c.So � ,r4�✓ bo/ AN O2. o 1 <br /> / c[ity State Zip -0 <br /> Property Site Address: (p 57 0 (t)c y xis Lo ks.. RJ {,Js�,s Tt.) t,J1 s-q jl3 . <br /> Contact's Telephone Number: ai - 3/6- f!.`/7 Z„ o N --. <br /> a\ n. <br /> Contact's Email: /I 0r a-i,2/ ( ?L ,_ 24 l 4,a h,.�4 f/G.Civ`1 ;. d <br /> Legal Description of Property: C.V Ls T G 6 £ F?T L Y(- S f!J , <br /> N <br /> Section#: 2.(.. Town#: t-[a N Range#: / G W Town of: b ca'/ J °= 00 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): / 3 Co t I <br /> Proposed Use of Structure/Addition: S hi a✓ a.-/GG rt <br /> Anticipated Start Date: ////J/Z a Zo (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - x <br /> ( ',i / 1 . a <br /> Building Contractor: � Qcy `/n/Lixd <br /> ah ,1. Sewer Installer: 4 ` O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , �J a -- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ti /- <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from then:prior to II <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured 'z ' <br /> home additions,and bunkhouses.** xJ <br /> 6 pla k,e, 5 t,4 ire-- 16 ti014--1( <br /> C \ 4 - ( e- of- roacZ <br /> �a Sum (0y,'��,u ► 5 a� ( QS/ 7; <br /> y r H cy <br /> O�W IAA- ( 1, //7L ,fin/ _ Fee Rec. �� _ <br /> 0 �OT 7TH U ��// m Check#:317'7 <br /> Date of staff site visit: ( 2-9 2-42z / Initials of site visit staff: /� /// L.i Z <br /> Z <br /> c <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: < ' t r-� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a i • fill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> lri <br /> ainfil <br /> Transcendent: - Page 1 of 4 +v a <br /> Laserfische: Burnett County,WI Land Use Application— Rev 6/2020 ,� <br /> c� <br />