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LAND USE PERMIT APPLICATION— Burnett County, WI a ' C <br /> . b <br /> Applicant Complete All Sections Below This Line °o <br /> Permit Types and Fees:(Please,check appropriate boxesJ�� a. <br /> a <br /> 2C Dwelling/Principal Structure Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration too Commercial/Industrial Structure $200 ...4)...4)� . <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck tairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 '�.� kw <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° r— <br /> Filling/Grading $150 Boathouse $500 r La. <br /> 9 <br /> Six Month Carrying tit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100r-- <br /> cn <br /> *NOT After-the-fact permits)ermit aquired after construction has begun)may cost up to three times the normal fee. c <br /> *Communic ion owers&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. -9 <br /> \ r 3 <br /> Property Owner's Name: � ,...d\ �vn -Oil' z <br /> 1 s Y83a m <br /> Property Owner's Mailing Address: 7 ' I 1' yr/SA.ec) Q, V r i 0 n;1/ W L o <br /> City "State Zip -a l <br /> Property Site Address: .5---": -e- d n 03 4, <br /> 7 �s-- �Yi-s V�� <br /> Contact's Telephone Number: o y <br /> Contact's Email: SO 1'1 b h P r t,V Q , CO d <br /> L <br /> Legal Description of Property: Z.01-- /y ►7p�1� ( Octk IGvd -5Aeire4 <br /> Section#: ((p Town#: t0 N Range#: (e W Town of: at Oa Es.1 N <br /> _ -W <br /> . 0° <br /> 5 <br /> P*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa e.* <br /> P <br /> Tax ID#(1-5 digit number; found on tax statement): /118.2%63 (AIA-6 (1)k a ' E. <br /> Proposed Use of Structure/Addition: 772Q,((i'. f 2 dh P 6c u S lk.• d e_CICi <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: S�'P Sewer Installer: -s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1rC <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ^- ,Z..) <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to r— <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** z <br /> 0 Penni-I-- \r t re S c�n iPok ►r- r rvk <br /> `` ss-i,( f b '' <br /> Fee Rec: Zieb_ <br /> 4 Check#: eCrfrA <br /> 71 <br /> Date of staff site vis' •.. / 1, *Initials of site visit staff: v > <br /> z <br /> - <br /> APPROVED BY LAND SERVICES OFFICI• r _ ; - 'at, 02 t')Q c)0 <br /> k RI <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF : <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .--,.., <br /> o <br /> CD c N <br /> Transcendent: Page 1 of 4 Aw N Q <br /> Laserfische: Burnett County, WI Land Use Application— Rev 6/2020 I G' WO <br />