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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d S <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 M <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 _� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 cb <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: (�f-�N� �� �'`'�j4Ll'Cc '�'�ise_kk,C ° z Iv <br /> o .. <br /> Property Owner's Mailing Address: c r)1 57:- £v€� 3.....c- Z,aC: � �t?s o <br /> n n City State Zip . <br /> Property Site Address: 135'3 C j v�C�C L tJ <br /> p 7/(= ���-X32-,+ 3 7/� -2� 2 a `w <br /> Contact's Telephone Number: <br /> nn ,, a • <br /> Contact's Email: (�.�`1�[/tf{^ ,'/ '1 //lip-L C Cn-l d <br /> Legal Description of Property: st / es n1 A s- P, 02,0 <br /> ro <br /> Section#: Zip Town#: 440� N Range#: / W Town o£ e 0 <br /> 5 o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 00 <br /> Tax ID#(1-5 digit number;found on tax statement): /3577 -. <br /> Proposed Use of Structure/Addition: EA <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> _ <br /> Building Contractor: Sewer Installer: ‘,C) ° <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 v <br /> o4K ex <br /> additions,and bunkhouses.** <br /> ( IAA. /S 4ex ad)•A me GUP 2--7/• 7 t ' pe/''n/41'71 <br /> ex ptire4 oil 9/6/ze za,• <br /> � <br /> o � <br /> lo' <br /> Fee Rec: <br /> LC Check#: 6 Via <br /> v <br /> m <br /> Date of staff site visit: Initi ls of site visit staff: <br /> y <br /> APPROVED BY LAND SERVICES OFFICIAL: — _ DATE: 0Ae7ZI tli <br /> 06Tffil <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CIXg .. Erin <br /> Mi.=r <br /> Transcendent: - Page 1 of 4 N <br /> Laserfische: Burnett County, WI Land Use Application-Rev 12/2020 [Mia <br /> ` j <br /> t <br />