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LAND USE PERMIT APPLICATION - Burnt,tt Cot.nty, WI = ro
<br /> Applicant ComPplete All Sections Below This Line '5' G
<br /> Permit Types and Fees:(Please,check appropriate boxes) °- ,—
<br /> Dwelling/Principal Structu.e $300 Addition/Alteration to Dwelling/Principal structure $200 d
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<br /> Commercial/Industrial Structure $300 Add'tion/Alteration to Commercial/Industrial Structure $200
<br /> Accessory Structure(Garage,Shed,etc.) $150 Adc tion/Alteration to Accessory Structure $150 O
<br /> Accessory Structure(Commercial/Industrial) $200 Add tion/Alteration to Bunkhouse $150 F
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bun<house $250
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<br /> Driveways/ CampgroundStructures
<br /> y /& $125 WI State Statute 59.692(1v)Structures $350 <
<br /> Filling/Grading $150 Boathouse $500 C-
<br /> Six Month Camping Unit One Per Year) $100 Permit Extension(1 Year Extension-AIIF wed Once) $100
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<br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. = r.
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<br /> *Communication Towers&Sigg is require a different application form;see corresponding application,and Fees. °'
<br /> *Items not listed above will be`rented as accessory structures,such as:pergolas,landscaping,etc.
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<br /> Property Owner's Name: ff c �-f E,--;,1 „(�'u, ,'`,/� z b
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<br /> Property Owner's Mailing Address: 9831 St h E. at`Ctieir^ ow 5,5s(59 $ ,
<br /> City State Zip .o I
<br /> Property Site Address: c51oc(,x e,, 1-:. d (, I
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<br /> Contact's Telephone Number: C.d. — 715 3,,Z”?7 o N
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<br /> Contact's Email: i'144.hi4r,d `/ ,-)&cirt,. .- / , d
<br /> Legal Description of Property: RC.Sitt,. 6r \
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<br /> Section#:_ !3 Town#: N Range#: 15 W Town of: .T ,{Cy,,-1 °'
<br /> *Attach additional page if needed for lengthy descrip`ion OR attach a copy of the deed OR attach tax system properly page.* d
<br /> Tax ID#(1-5 digit number;found on tax statement):_ (m(0.S Fi'
<br /> Proposed Use of Structure/Addition: ,.�,.
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<br /> Anticipated Start Date: joj.264;2/ 'Home/Cabin;Conm:ercial Business;Bedroom;Deck;etc.) C f y
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<br /> Building Contractor: Ot,,,,y ,, Sewer Installer: ,°i,-,.‘,.
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<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENT'S/CONDITIONS ONLY
<br /> T)IIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> *"*Tire applicant needs to contact their UDC Inspector to deter•ruin,if a permit is needed from them prior to .‘
<br /> NY construction taking place for any dwellings, dwelling additio is,manufactured homes,manufactured 2
<br /> I nine additions, clad bunk/„a es. YIr�, ` On SeP,iG todi (j f 1 J).-1
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<br /> i Fee Rec: /5o4°-
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<br /> Check#: y/'19
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<br /> Date of staff site visit: Li (6/ -1 1 f site visits a .. - - '/L
<br /> Initials . / // 'i
<br /> APPROVED BY LAND SERVICES OFFICIAL: 0'44 A 4/,0" DATE: /5/?-1 < ___
<br /> I_ PON APPROVAL: APPLICA "� . UST POST COPY OF coa Q.
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a m o
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<br /> Transcendent: Page 1 of 4m "E, I
<br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < g
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