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LAND USE PERMIT APPLICATION- Burnett County, WI f @ <br /> Applicant Complete All Sections Below This Line 5' g - <br /> Permit Types and Fees:(Please,check appropriate boxes) °' W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i9 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Byyr rptfs2 $250 .� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 P <br /> Filling/Grading $150 $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> r <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. q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: % /CA' 14" ,�j// ley',/f,../. <br /> o . <br /> Property Owner's Mailing Address: e, ,. /t." 4,12-t://0/4//6/.e. j ee/p/ $ <br /> 0. <br /> �j /� T City State Zip <br /> Property Site Address: //7L /eede-,/y ,ed „5-5:4//y--(33;-' nrk, <br /> Contact's Telephone Number: 775".-.2,R U - 60F, i <br /> Contact's Email: G ' //e2 o ,0.-'-ve ,f/d��SUtx ' i2l�/''''F - C 413-1—L- • d <br /> FO <br /> Leal Description of Property: GG L' O <br /> g P P rh'� �,L .CDT r/ �10� //� ,�`.�..�/� (�'� ..?/> <br /> y o .- <br /> Section#: X74/ Town#: •7-- o N Range#: i(�/y W Town of: $Lc77 <br /> ro <br /> ric <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number; found on tax statement): r/8 / <br /> Proposed Use of Structure/Ad ition: lj/j, -Xi--//( v) <br /> Anticipated Start Date: —/e__ .2c7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ox <br /> =o <br /> Building Contractor:4'6, 44r_, ',,C4? Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Dq <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.** xl <br /> 7AI s e-vis All— I S - .),,i ,r t- pcm o aAd v4 rte)6u s <br /> 14 lk vogys cold 1,001 IS aSAoWpt. • <br /> Fee Rec:Zia' <br /> Check#: — <br /> 7 � a <br /> Date of staff site visit: (I/5.- zO Initials of site visit staff: i l! Z o b <br /> m ��� <br /> APPROVED BY LAND SERVICES OFFICIAL: / 40 DATE: 6//7/Z49 /z < w <br /> .1. s <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF Gird <br /> (g 0^ <br /> -r0 co Yyu <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y o <br /> N <br /> Transcendent: Page 1 of 4 n a <br /> � czt <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 3 i <br /> o �� <br /> cn <br /> a <br /> 3 <br />