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' LAND USE PERMIT APPLICATION-Burnett County, WI a `° <br /> Applicant Complete All Sections Below This Line 8 o <br /> Permit Types and Fees:(Please,check appropriate boxes) n d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> a <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 ' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 5 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk\c. <br /> Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> VVV <br /> Filling/Grading $150 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 li <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g <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 /> f �, P r <br /> Property Owner's Name: /1-1, 1q (e9#9 r o <br /> / Lc- r <br /> Property Owner's Mailing Address: .n�.[(o/7 1A-Ls4//541 vim(¢ cif Pt.ej4Q `' '�-- $ <br /> City State Zip b <br /> Property Site Address: 2r3(r,a6, 574y- ,,/ pzett,L { 44 4ted caz sin 70 ' <br /> ci <br /> Contact's Telephone Number: lis- 6.57- k86 r � . <br /> . g r, <br /> .. . <br /> Contact's Email: lar, t,/?jos,a_le gyit Ikdd,. c P-~- la <br /> Legal Description� of Property: S//c/ S (/ S i 7-3g /Alt (Z1 (Y C 'a N 1 <br /> Section#: t "i/ Town#: 3� N Range#: /K W Town of: /3o ki6/ g °Q <br /> 5' <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C7 <br /> Tax ID#(1-5 digit number;found on tax statement): 3 30( R' <br /> Proposed Use of Structure/Addition: L"Cee, /0 y.Lz, c7) <br /> Anticipated Start Date: T^-(— ti-C, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o ' <br /> '-- <br /> Building <br /> Building Contractor: dw,Vt '►Z Sewer Installer: <br /> ymor <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** z <br /> g Fee Rec: /.25-9 <br /> Check#:'D' 9---) <br /> Date of staff site visit: --47c:� In Is of site visit staff: <br /> )c.___- <br /> APPROVED BY LAND SERVICES OFFICIA �TDATE: '��Z='r-'c�`-` <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF PI "- IT <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTt c) LO <br /> RI <br /> Transcendent: Page 1 of 4 g <br /> 1= cN' < <br /> 18 <br /> Burnett County, WI Land Use Application—Rev 6/2020 t� <br /> Laserfische: gin) <br />