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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> • A s s licant Corns lete All Sections Below This Line a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> k) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 2, ir <br /> 6' <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 si.' ' O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ," , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 g' 10 < <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> Li <br /> C ' <br /> *NOTE:After-the-fact permits(permit squired 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. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -0 P <br /> 1 r <br /> Property Owner's Name: Lck V� r C.C- r1 ?6' A 4-t-e,�.5�� ° ..-4: <br /> Property Owner's Mailing Address: 2_68 i--1. .ZC..E( oO', & (3s 41, al ust. $<ffr3 g <br /> City State Z.i b <br /> Property Site Address: 2 Lige,5.- �l 1Xr%/1_ 5 4zz 1` L tt1/1-12 5 1 C.tL� t 5`/8-7 2 ' G <br /> 4 I <br /> Contact's Telephone Number: 0 15 `3 27 -.� 3(o o <br /> $. <br /> Contact's Email: 0.V el O C-t- 1 9 `(0C yAk, .•.. (,-C,...., d <br /> Legal Description of Property: LoT 4 NI,t r`)i( 04-Tiv__ S.E_'ly 04 14 '14 5E-14) <br /> N <br /> no <br /> Section#: 3 5 Town#: iq N Range#: 1(0 W Town of: IN e er n.r 0. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* b <br /> Tax ID#(1-5 digit number;found on tax statement): 12J-11 2 <br /> Proposed Use of Structure/Addition: /4 d m C "' <br /> Anticipated Start Date: 6- ( • Z.U'L% (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: d <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured 'z <br /> home additions, and bunkhouses.** <br /> • lt it tE.f ekC eecc a bed c' <br /> , Mee3A-* 564)1)4,6 I <br /> Fee Rec: <br /> 1/4 <br /> y Check#: 6tit•ir <br /> 2-5/ VI <br /> Date of staff site visit:5/ / Initials of?to visit staff: t 1 z <br /> APPROVED BY LAND SERVICES OFFICIAL: �� <br /> , iI ./�%� DATE: 6/i/al'I rz <br /> < w <br /> UPON APPROVAL: APPLICA Ir7�� I W g n <br /> UST POST COPY OF � 3 -.< <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 CD o -.4 <br /> Transcendent: - Page 1 of 4 n 119,,< <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 I' _ fi <br />