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LAND USE PERMIT APPLICATION— Burnett County, WI f b <br /> Applicant Complete All Sections Below This Line 5 o <br /> Permit Types and Fees:(Please,check appropriate boxes) ° —C" <br /> Dwelling/Principal Structure $300 'x Addition/Alteration to Dwelling/Principal Structure $200 d v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> F.1: <br /> 4-..1 <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692)ly)Structures $350 o r <br /> Filling/Grading $150 Boathouse $500 o 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 x <br /> *NOTE:After the fact permits(permit squired after construction has begun)may cost up to three times the normal fee. 4 <br /> 57 <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 /> co <br /> Property Owner's Name: ke,i t 4- T -e-r-e s cA- A Q c S O o <br /> Property Owner's Mailing Address: 2.--7q‘73- of0S-Q I 'r Wbdev u , 51Y -3 °o ,� <br /> Rd /n� ' J'- "City State Zip -0 <br /> Property Site Address: 5 �iy l' y-vr LV: S` 46 93 n <br /> Contact's Telephone Number: -?/ 5--- e,1-- //6 c o F ' <br /> II <br /> Contact's Email: CO LJ`r►ki S tae etc'?9S C. Q I' <br /> 4 0ury� ' i *et- <br /> a a <br /> 1("25 c5.- E <br /> Legal Description of Property: <br /> N ao <br /> Section#: r 0 Town#: 4/0 N Range#: /5 W Town of: . 1 kSo n =_ <br /> r• <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach lax system property page.* v <br /> Tax ID #(1-5 digit number; found on tax statement): $ 3 / 4, <br /> Proposed Use of Structure/Addition: Perv(�u..s �f 1 d ,3creeh pcifc)i, cn <br /> Anticipated Start Date: c <br /> p av� ?� r Zc)Zq (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> ;,�) = C7 <br /> Building Contractor: ' d-a in <c?S S 0 A) Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to C <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** Pv <br /> Lt7 <br /> Fee Rec: QC — <br /> U Check#: <br /> r O <br /> C/�J"L7� <br /> Date of staff site visi — 30 t✓ Initials of site visit staff: ii, rrla <br /> M� v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: -L" < �—' � <br /> F y E <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF H cnco c <br /> > cor <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° 6 ° N <br /> C t.., <br /> Transcendent: - Page 1 of 4a <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 < - c'' <br /> fin <br /> 0 <br /> E <br /> D <br /> 3 <br />