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LAND USE PERMIT APPLICATION — Burnett County, WI o <br /> Applicant Complete All Sections Below This Line z' . - <br /> a <br /> ' <br /> 'Permit Types and Fees:(Please,check appropriate boxes) 9.....,Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure 62009) d <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 /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 J g <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- S <br /> in Unit(One Per Year .--.. ...•Six Month Camping g ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. cAG <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. w <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: I Qtw 4 - tkr-HI or-- 1A/L.: , ± z <br /> `j I , 7 o ___\F. <br /> Property Owner's Mailing Address: \' C) l k) Cid S� -�' /1�, JCJ �5 0 <br /> City State Zip c Q <br /> Property Site Address: 37 7L2 0Nit (Zd A • tkic v Ss-�4--- u' l- 5-'L/8 c 3 5 <br /> Contact's Telephone Number: Le S) — G-S-14 1 0 t U 'S"--� o <br /> E. -4, 0 <br /> Contact's Email: a(.-fUr al Vly:;'-'1--- 7(..Q e i II 1,(1 l' I' ad r1--) o z d <br /> Legal Description of Property: L-5 e t b 012. -�a�if - :0 1-(00 1-1 I �� N ^o <br /> Section#:dTown#: 4K N Range#: l 5 W Town of: V CLC-kc-SC1n 0 04 <br /> 5' <br /> *Attach additio gal page ff needed for lengthy description OR at h copy he deed OR attach tax system property page.* O <br /> CAI L-0 t C� D�S G O c-o t 3 51 3`f . <br /> Tax ID#(1-5 digit number; found on tax statement): 5' p C S <br /> Proposed Use of Structure/Addition: 1 1. (i1 de dz.. C•abl(1 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> Building Contractor: Ari-hur n-I VVI L . + Sewer Installer: Wade Q u-P5 b O 1 ( 1 n <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, man factured homes, manufactured Z U\ <br /> home additions,and bunkhouses.** fix) T <br /> oe 4115, °' ,5 o ��te a-5� al v <br /> x �' 'o 11 be- ckA( w, <br /> No � 111 e-- e Krns` 5 <br /> \j,(;00102-• <br /> x Fee Rec: 3.0CY:7 <br /> L o Check#:10377 <br /> I- <br /> Date of staff site visit: /i 3/ / Initials o .ite visit staff: L z <br /> APPROVED BY LAND SERVICES OFFICIAL. A <br /> DATE: //11/)1 i <br /> En <br /> r-m <br /> ITiii <br /> UPON APPROVAL: APPLICANT UST POST COPY OF 0.3 M (5SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> gifil <br /> it-S w <br /> 0 <br /> Transcendent: - Page 1 of 4 6Q <br /> Laserfische: Burnett County, WI Land Use Application-Rev 12/2020 �': <br /> ac <br /> uuu <br /> 24 <br /> V. �Q—�-J <br />