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4 <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a 1 <br /> b <br /> Applicant Complete All Sections Below This Line o <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `",. .3•\X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Acessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,.C. ° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - `\_.9, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °° f\" r <br /> Filling/Grading $150 Boathouse or$500V% <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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. $ ,t" <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: !p S ep _ i{ i'Schf F <br /> 'z <br /> 0 <br /> D <br /> Property Owner's Mailing Address: IT3.1;j9 E `i)Clt,0w ( t e-v- QQ Uanb.i.q-y ,WI 54i'i3v $ V) <br /> City State Zip $ <br /> Property Site Address: 3... .'15 q E ‘1(v...\\ 1/4.,... (. \Q zf 2 c:&, 0 C4.e\b, ..r- 1 , W I 5 9 S 3 cd r <br /> Contact's Telephone Number: (01) 46et -q dS(a o c <br /> CD <br /> Contact's Email: ;\�',/-sL-4) u.5, %rcr .Ce, d <br /> D. <br /> Legal Description of Property: I--( to - a ' PNek&,icsD'n Poxc9.0.1\s Q..;0-42,e P'nV5 <br /> 0 <br /> ao <br /> Section#: (ee Town#: i-i o N Range#: (lo W Town of: O 0_14.t 0.n d ❑ <br /> 5' <br /> " <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertyPa%e.* 1 . <br /> - <br /> Tax ID#(1-5 digit number;found on tax statement): 143 i fo �' <br /> Proposed Use of Structure/Addition: O'er-0—;ti.Se / Shea `n <br /> Anticipated Start Date: -3- -rv.. i dO at (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) s <br /> Building Contractor: SJh Qr Min L. AVO:ie--r',Zln C. Sewer Installer: <br /> t�fA d <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY —.0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C.'`) <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.** m <br /> yv us-f' 411 o w q i l co v.d �A' -►'o v $ re-Y Im're.oll per r vM-2( - 0 9 <br /> ©wNev -i yvi e,d" / peeUloU3 Y`egu►re esi by <br /> uliN9 ,4000ms p ,4vt,'S and 5owle Pot: r <br /> do!►1.9 a 9,69' i v) pe- t,-. ► f... x Fee Rec: PU <br /> .-- <br /> 10 (>'ruV/a�° <br /> r10.1— 4!" AUt"nq✓' 4q LI i0✓� <br /> 10 6Check#: `Ufa <br /> a <br /> Date of staff site visit: 3/)k/9-1 Initials of site visit staff: 1- z <br /> APPROVED BY LAND SERVICES OFFICIAL: / _ DATE: /f � Zi( < a <br /> X 1 Liii,} <br /> UPON APPROVAL: APP 'CANT MUST POST COPY OF H pa <br /> ,ks <br /> __. ,„„„ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> IlL <br /> _ o <br /> J 2 <br /> Transcendent: Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 •- -- ---. <br /> o � . Jj <br /> s• <br /> 6 <br /> ro <br />