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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> 7 N <br /> Applicant Complete All Sections Below This Line ° �' <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 . cJ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..,^ s1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 f h <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 — . . <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> c <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° N <br /> Filling/Grading $150 Boathouse $500 — 1.1, a' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. v 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: Lob_f !Grrt i e- CI-)m t ( 7. T. <br /> o • <br /> Property Owner's Mailing Address: ,3C{ 0 Mer-I >7 o ACit 2 o c,.s.-. 4111) J a ' <br /> 1 _ City State Zip <br /> Property Site Address: y 7 7\ 1,N/ riu Lod6 eod j-J P,1 S tex �' <br /> Contact's Telephone Number: 1Z. (i`--N 3 v 9.1 ' o 7 a <br /> Contact's Email: -± Vl i b ( S C.,Ie"2 r-v- __L Cm` r-k2 l.i 1 , C..0 rn o <br /> v Legal Description of Property: Cx,\\ --thc,k pa, ' O Jr)* N <br /> pp � o ao <br /> Section#: 4 Town#: o N Range#: f$ W Town of: �,6t_\le.. <br /> 5' <br /> *Attach additional page i neededfor lengthy description OR attach a copyofthe deed OR attach tax system property page.** as <br /> P g r g Y P Y P P h'P S p <br /> Tax ID#(1-5 digit number;found on tax statement): c <br /> Proposed Use of Structure/Addition: , 0Y—CL c4 <br /> Anticipated Start Date: 0Ct 2'1 C ome/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor:Old }{t Lt6► ...t Sewer Installer: <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 .1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z S6 �!� <br /> home additions, and bunkhouses.** <br /> 01hu.�- Mee} 4,ll 5e- � <br /> a �µ m Jb 5 O I <br /> x Fee Rec: !5-Del? <br /> Check#: ii/4gam <br /> Date of staff site visit: ICI lie !O a + Initials o site visit taf. Vr z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: .O/ z/J.2199% <br /> ligil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a. o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCO 07 <br /> CD c <br /> - 2 NI <br /> vS <br /> Transcendent: Page 1 of 4 cam'= <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 _ 1'4 N <br /> V POi <br />