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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line ° o. <br /> c N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 s) Addition/Alteration to Dwelling/Principal Structure $200 1::2 t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> �' V <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 i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 N <br /> Filling/Grading $150 Boathouse $500 t* �? <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100J <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. F. t <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,5 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. v <br /> Do.-a- t e 1 (nc d` q s ~ <br /> Property Owner's Name: ! 11`� '�'-�0��`� <br /> P vii <br /> � <br /> Property Owner's Mailing Address: —1 53 Mw' 1L hY1 ,AY`t, i Rticisoyi IM01 6 $ <br /> �- V© �'�1 ( StateWl1S 1 n , <br /> Property Site Address: (�(C�, <br /> Contact's Telephone Number:T1(5 - l0'3B 01 96, P.- o g <br /> Contact's Email: t \ 4 I g tf l I icer }C bf• mtj / a 1 <br /> o <br /> Legal Description of Property: ®CNA& Pt i -- I4a � 16 NI <br /> PN <br /> v <br /> \ u� N b 1 <br /> Section#: Sk 01, Town#'T3o NI N Range#: R� 1 W Town of: - w <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t7 <br /> Tax ID#(1-5 digit number;found on tax statement): ! F3' <br /> Proposed Use of Structure/Addition: G -P actrt, iftill I 1 l.{ coo 1i "' <br /> Anticipated Start Date: t-J v. 1 , " ..,4:›2..e) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o go <br /> Building Contractor: IA l t' C -IS- C bn Sewer Installer: <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 cd pQ <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes, manufactured z <br /> home additions,and bunkhouses.** Po <br /> N. <br /> r , kY v\ 14ahI'4-14 rCle1A1)2" <br /> x Fee Rec:35 0 ma `- <br /> 4. Check#:l�'a29 <br /> �1 a <br /> Date of staff site visit:/Jl �a paO In' ' is of site visit staff: a <br /> � <br /> cA <br /> APPROVED BY LAND SERVICES OFFICIAL: E: /J 7., do— S <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ® C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo �' <br /> � ; N <br /> C <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 < c , I <br /> a <br />