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LAND USE PERMIT APPLICATION - Burnett County, WIcr <br /> o <br /> • N N <br /> Applicant Complete All Sections Below This Line 0 o <br /> Permit Types and Fees:(Please,check appropriate boxes) a a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d OQ <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 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250e lv <br /> G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> VI <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <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 /> '` -/- !V A 1J C Y L. , a ,q 2.'T t A ki r z 1, <br /> Property Owner's Name: 0 1( '' <br /> I co OA It 1 s C.� o o Property Owner's Mailing Address:al 6 0 R t v. - ,E� 1t7LieL)i2Y �'iCity State Zip b <br /> rill <br /> Property Site Address: .2 2 4" 4'.•4--le- DO r 11 a" 0 n <br /> Contact's Telephone Number: p g % . - q 7 3 - o F b <br /> c.Contact's Email: n Y <br /> e v \"f"b ) Cj q j S" Y A i-�vCO M d ' <br /> vw <br /> Legal Description of Property: 07-0 3 Z- Z - 5/I- 2 6 - ! 3-.. OS - oo V- O 12ood .. <br /> N m <br /> Section#: 3 3 Town#: y ) N Range#: 1 to W Town of: S t --C-5 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> 2272 <br /> Tax ID#(1-5 digit number; found on tax statement): 2. q" <br /> Proposed Use of Structure/Add' ion: OAe7 " <br /> Anticipated Start Date: 7 // 2 ea 2..c, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> a a <br /> Building Contractor: 0 W N t✓Fe, Sewer Installer: <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY9.3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `�• tJ <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 NI <br /> home additions,and bunkhouses.** %n <br /> x Fee Rec: la. 541) <br /> Cil <br /> �l 4 Check#: 5,-,`7 <br /> V <br /> Date of staff site visit '`�� — ©o�In' 'als of site visit staff: ' r <br /> i ....._ .,,d <br /> APPROVED BY LAND SERVICES OFFICI DATE�—fF"� 63-0 < <br /> F, a 4..... fiii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 .5 = <br /> SIGNED PERMIT APPLICATION IN PLAIN ,3 <br /> **Tr- c CO <br /> 7s <br /> Transcendent: - Page 1 of 4 g 2. e'er' <br /> Laserfische: Burnett County,WI Land Use Application—Rev 6/2020 < (1) 1 ______ i j <br /> � ( <br /> C 2/ <br /> ro <br />