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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line $• <br /> a ' <br /> Permit Types and Fees:(Please,check appropriate boxes) >` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I. <br /> C <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 �O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 "6" ° <br /> A Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> X Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °e L� <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CP <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. 'CD <br /> b <br /> .. ' '^. 'e <br /> 0 <br /> Property Owner's Name: , _ ,0 , iA I �: <br /> hi t o nip <br /> Property Owner's Mailing Address: Pay x „ ir11mLt\--,_i_. oo W <br /> city State Zip n <br /> Property Site Address:k.2g( (_ Rcf F. <br /> Contact's Telephone Number: 1 t n — 39i 0 _, k--11-4 l,2S III <br /> 3 <br /> j4e 0 .6' <br /> 1 ea. <br /> o <br /> Contact's Email: Ve1'�a o{ cv not ecC.l%pPe open I—� e5, c circ' ,� e <br /> Legal Description of Property: .. <br /> N -c <br /> Section#: Town#: N Range#: W Town of: 8 fro <br /> ace <br /> *Attach additional page if needed lbr lengthy description OR attach a copyof the deed OR attach tax system propertypage.* <br /> 7, <br /> Tax ID#(1-5 digit number;found on tax statement): 2. <br /> Proposed Use of Structure/Addition: 1>C-'C k `" <br /> 1/• yr <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) l- y. <br /> Building Contractor: Sewer Installer: (..0 o <br /> .- <br /> AREA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTSlCONDITION5 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 then prior to O <br /> ANY construction taking place for any dwellings dwelling additions,manufactured homes,manufactured z <br /> 7d J <br /> homadditions an bunkhoyses.** <br /> 9r7e <br /> e+ a l( 5-C/4 `d113 <br /> Fee Ree: /Q51--1? <br /> u, <br /> - <br /> y Check#: Cilrilii <br /> d <br /> rri <br /> Date of staff site visit: ,s/la I (9.1 lniti• s of:ite visi taff: •10- <br /> EA <br /> APPROVED BY LAND SERVICES OFFICIAL: I , � DATE:�a/I6/? I ri <br /> e 0 <br /> CD7 f" <br /> UPON APPROVAL: APPLIC A v'// UST POST COPY OF VD CO <br /> a a . fill <br /> io <br /> G11 0 <br /> SIGNED PERMIT APPLI ATION IN PLAIN SIGHT . 1 <br /> -C y NO <br /> Transcendent: - Page 1 of 4 �n W2 r.. <br /> Laserfisehe: Burnett County,WI Land Use Application—Rev 12/2020 i PO Q <br /> Irtfaa <br /> Lc________)_-) <br />