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LAND USE PERMIT APPLICATION —Burnett County, WI e <br /> Applicant Complete All Sections Below This Line s c o <br /> CD <br /> , <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 r <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 2 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> g k` <br /> c, <br /> � <br /> Property Owner's Name: e,�5 c � ' 0,.`••,$t 1n o <br /> • <br /> Property Owner's Mailing Address: -11^ Si- Ci 1\► / '` n/V 550808 ogi <br /> 6 <br /> �yR f City . State Zip <br /> Property Site Address: ca �0 a C j....- <br /> Property LAN' C,1�wvi b✓1 gni! z c <br /> C J n <br /> /. <br /> Contact's Telephone Number: .. 1 — 5v 7 — /� G}-,).. o <br /> .65 <br /> Contact's Email: G t/m <br /> ei\S 4-11-140 '-)m vi--Tho <br /> a, 1 .. C 0 T <br /> 2. <br /> Legal Description of Property: 7 / G/5M'1 U e/ 4 4s--e___. <br /> 0 00 <br /> Section#: p�Town#: 3 7 N Range#: /O W Town of: r Z.-et� 0 <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPaSe.* <br /> I . <br /> Tax ID#(1-5 digit number; found on tax statement): 2. '37 Z 7 <br /> 5. <br /> Proposed Use of Structure/Ad 'tion: riV.3 JiV S‘,..,2,1 ciQ'..)�'1 K%y 164 ice_ <br /> `r' <br /> Anticipated Start Date: �i\'\ 1r ���V ) (Home/Cabin;Commercial Business;Bedropm; o <br /> Deck;etc.) g <br /> Building Contractor: 0 ,n) V'✓WSewer Installer: i y� <br /> v/ 7d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 'J <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z N <br /> home additions,and bunkhouses.** o <br /> --- /Vet 747 toe usc " -;•^ 414P-tom / /0// 4n. <br /> it/1 '4W- wl e,LT1. 4I/ s (peacA, , <br /> x Fee Rec: Ica—IO- <br /> y Check#: Z5o3 <br /> o <br /> rn <br /> Date of staff site visit: 7/I 7/ ZO Z9 Initials of site visit staff: ,r/// lir , �`��APPROVED BY LAND SERVICES OFFICIAL: DATE: 9/01/06Z0i Iiiiii <br /> a <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF H s 0 <br /> RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g O <br /> Transcendent: Page 1 of 4 . Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 6/2020 MU <br /> rn <br /> L J) <br /> ro <br />