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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 <br /> CD i <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 XAddition/Alteration to Dwelling/Principal Structure $200 C7 <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 Ns �O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 K) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ib <br /> *Items <br /> Property Owner's Name: /.1 r,-,,,4 t rio., k I r c /4 ° <br /> Property Owner's Mailing Address: Co O'i 3 i�i lc( 11 k l<e JG1 webs fe /N/ S-! aY$ g <br /> / `' t City State Zip <br /> Property Site Address: Can I, P/ /err 1-,,--Ice IC(1, LJz ,'/`e,,r' I.,/1 c-4-/'J j i cn„ <br /> Contact's Telephone Number: 7/ S 0 3/--1 F <br /> • C <br /> Ve. l� 6e061.I.co✓1'7 d <br /> Contact's Email: a <br /> Legal Description of Property: <br /> ^i N `v <br /> Section#: cC`,) Town#: i N Range#: f'te W Town of: ill C eiv C i 1' 0 °G <br /> ' <br /> c` <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa e.* <br /> P <br /> Tax ID#(1-5 digit number; found on tax statement): /( C i> 7 T. <br /> Proposed Use of Structure/Addition: k'i t•••1t C ' Gil <br /> Anticipated Start Date: S e l f 3, - o A, <br /> p 7 i (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: A Z Sewer Installer: d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 11CZ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <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 01 <br /> home additions,and bunkhouses.** S P:jfv\ 4-nq 4n�'�ote b al/oo <br /> o - 144-er& ) eqk'1Sio✓1 w;ff-n. +6 75 Sef <br /> op '-+ O' $ �' 444 We ra ( elk()s, <br /> i ' 4 <br /> V x Fee Rec: oa'n6) <br /> L o <br /> Check#: C <br /> tri <br /> Date of staff site visit: 1 I/ LI ` 2 1 Initials of• to visit staff: �� z <br /> r,r4______E____::j <br /> APPROVED BY LAND SERVICES OFFICIAL: .,��///�DATE: "�/o4�( < <br /> UPON APPROVAL: APPLICAN-'� UST POST COPY OF wBill <br /> rn G) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTn . <br /> Nil <br /> Transcendent: - Page 1 of 4 c <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> -+1 <br /> a 1111 � <br />