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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line '' 0N.+ <br /> Permit Types and Fees:(Please,check appropriate boxes) a n <br /> Dwelling/Principal Structure l$30 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `, 0, <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,-.1 0 <br /> cam, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 t?'� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - 3 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse <br /> $500 C- il•j ,--_, <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 t <br /> CA <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. A) <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. II'. 4111 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> Property Owner's Name: ;/I a4)a y1 ° 1 <br /> !a <br /> Z <br /> �osd. 'i (..t/ 51 21 'A' <br /> Property Owner's Mailing Address: )1? / ,) ,f7 y a. a'� " o <br /> ) ,City State Zip <br /> 0.. t <br /> Property Site Address: 41 17 TI'r.✓cye. Pr a h L)+7 14/, z.7 n <br /> Contact's Telephone Number: ,js; .7'y )8 I I* 11:-.-r. o N <br /> CD <br /> Contact's Email: ha vie/ ( 'h 7 f> 1.611i,I, 12dd <br /> f a, <br /> Legal Description of Property: l/cl 4 bra 3r (3+rXrd w::rr (.Cjj Im' 0 <br /> Section#: 35 Town#: y/ N Range#: ft W Town of: S,,,,',SS 0 00 <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): ,;D.07 <br /> Proposed Use of Structure/Addition: C irb f r) r <br /> Anticipated Start Date: 7 S�' ,2,/ (Hom abi ommercial Business;Bedroom;Deck;etc.) o k <br /> Building Contractor: '"B 1 .h' it,✓ ZU,41/0j/et: Sewer Installer: -!I. 4 4,J1 j" £35/ <br /> 7 H <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 additioni d bunkho .** ._ (, b� <br /> 3 � <br /> Need Qerm,4 sc9e CAT ifc- <br /> be Kepi. b� )21 1121 <br /> � <br /> z Fee Rec: _r 41 <br /> En Check#: <br /> j/131? 1 / <br /> Date of staff site visit: Initials of.ite visit st. f: � `� z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: $ / DATE: 71 '1/7 ( m ��"./ <br /> -6. r- <br /> RI <br /> UPON APPROVAL: APPLICANMUST POST COPY OF a �CI3 c 115 <br /> I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° - G� <br /> Do <br /> Transcendent: - Page 1 of 4 m <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 M� <br /> a <br /> 3 <br />