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LAND USE PERMIT APPLICATION — Burnett County, WI cc <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) ,,- c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O �1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I�v��� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 P PD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 R <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r- <br /> o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r, ►4 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ° L <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. n ' e, <br /> r g • <br /> p,Property Owner's Name:%1., ri K(�t�1\1 CAJ�� 14—r, �� ° o i <br /> Property Owner's Mailing Address: 2L 3 HO 0.), e o fJn1�; �S L. ice- ed . o <br /> City State Zip <br /> Property Site Address: 27 3410 i) c o(GAJ C-(,!S L 1u (2 O �• <br /> Contact's Telephone Number: 651 — 2 7 6- © 7 7 70 1 <br /> Cei..+-6 V LC r 3 417'15 ontact's Email: b LJ leo c../c../.1, I` G�(,r) nl1,t�,, 1 ( SYvl <br /> r„ <br /> Legal Description of Property: `�incl IC. curl.-+1 ,l ✓ ;l <br /> l IA .e.5.tt)e NI i'-i --( ,`„,, <br /> Section#: Town#: N Range#: W Town of: 0 At4 L.A1'4 PS/ll :,?J aq <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page,* 5'I o <br /> Tax ID#(1-5 digit number; found on tax statement): — j L{ 0 Li <br /> Proposed Use of Structure/Addition: 5 t.FJ( . ifN.I+,N,,Cl,,LA,l ) <br /> Anticipated Start Date:Qi 1100 e6-4•441 v1411f4 Al( me/Cabin;Commercial Business;Bedroom;Deck;etc.) o . <br /> Building Contractor:WLM t:.t. tJ 6 f, i,-) Sewer Installer: 9 CI <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 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 /> MI fri ei— G41( 5eirb ackS <br /> kS <br /> ig tiphold r414� <br /> Fee Rec: / <br /> N Check#: No3/ <br /> Date of staff site visit: Li ( 7/! �' Initials of s't visit .ff: If� I l'-' . <br /> APPROVED BY LAND SERVICES OFFICIAL: 4/j DATE:S/�D/p1-/ < <br /> UPON APPROVAL: APPLICANT M ST POST COPY OF n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTla - fill <br /> , voCD c� <br /> Transcendent: - Page 1 of 4 773.' 2 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 = <br /> 3 <br />