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LAND USE PERMIT APPLICATION- Burnett County, WI a iro <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Please,check appropriate boxes) a ,�• <br /> j� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d b <br /> co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 'i.. <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <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 o ir <br /> Filling/Grading $150 Boathouse $500 r 011 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 0 k' <br /> r <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. n v) <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. CD <br /> Property Owner's Name: C.ho,( 1 L S V) I-IC(k YY1 G Ps' • <br /> Property Owner's Mailing Address: 7 703 Oiceiv RQyj L bSte f kA), yv i3 °o IP <br /> r <br /> y <br /> stState Zip i. <br /> 11(?3 Oise& I � '.) f 19 e r 5 S/ 'c3 E. <br /> PropertySite Address: <br /> Contact's Telephone Number: Go 3 - 33 q- 56 a ('I - , ° <br /> F, <br /> a <br /> Contact's Email: C C h0 Li nt a& Ce Al S )1: , C c'iri C7 <br /> K <br /> CD <br /> E <br /> Legal Description of Property: I,J I - t-� S `—Y - 9 <br /> N b <br /> Section#: j f Town#: 3 9 N Range#: 1 1 W Town of: o p rt f C o I r,/ . <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): 1 0 5 04/ n. r <br /> / / <br /> Proposed Use of Structure/Addition: Puff u ,d X , c1 S h e d ' ell t o Ct y vo(,i i IT `,, <br /> ,,( .--1 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroo Deck;etc.) s <br /> d d <br /> Building Contractor: Sewer Installer: y E— <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 creeds to contact their UDC Inspector to determine if+r 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 /> n Nd+ 4 twain"? Plot b, 0 / <br /> 0 Mr-e+ c,!( 5ef sacit5 <br /> Fee Rec: 15012. <br /> y Check#: (L:,---2-7 <br /> aglar ° <br /> 01 <br /> Date of staff site visit:6tInitials f site v' its '' <br /> z <br /> 0 <br /> rri <br /> APPROVED BY LAND SERVICES OFFICIAL:Aii f /1/!/ 1 DATE: 660( < ,--J—C�- <br /> UPON APPROVAL: APPLICANT `UST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT co co CZ �� <br /> -G !A r•-3 Y u t <br /> Transcendent: - Page 1 of 4 v i r.a <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < a< <br /> °rri (I)fM <br /> a <br /> ro <br />