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LAND USE PERMIT APPLICATION — Burnett County, WI 0- 2 <br /> W < b <br /> 7. <br /> Applicant Complete All Sections Below This Line ' G <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> : 0 <br /> Commercial/Industrial Structure $31a Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) is Addition/Alteration to Bunkhouse $150 co <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 56 i <br /> Driveways/&Campground Structures o <br /> pg $125 WI State Statute 59.692(iv)Structures $350 A <br /> Filling/Grading $150 Boathouse $500 C. p <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> rn <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro i, <br /> Property Owner's Name: , JC 7 z <br /> i ... <br /> / <br /> /� o <br /> Property Owner's Mailing Address: /1'5 /'24 bl /e lil,l 5%��3 °o <br /> City State Zip $ <br /> Property Site Address: G]//1"1 -. z n <br /> Contact's Telephone Number: 7/ ' --“ 5r----4--- 64 / o y <br /> Contact's Email: G-l'tt.G4%60(i 66 �/)/./41-,-0t) ' CM �`� • a <br /> d <br /> w <br /> CD <br /> Legal Description of Property: N 1/7-- IU VI--W vV SSW f .. <br /> N ro <br /> Section#: 3 14 Town#: i-f ti N Range#:/ 4 W Town of:_ SLv I"- . . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 00 <br /> 7 <br /> Tax ID#(1-5 digit number;found on tax statement): 1 3 8 ©Z 0' <br /> Proposed Use of Structure/Addition: Sir *Z A c-- . <br /> Anticipated Start Date: SbrN e ZC�( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: eti-yam d <br /> at - U Sewer Installer: i(J <br /> y Q <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,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** <br /> 0)111;b Qeittif I C419 ;Pr +tie ;; <br /> NortO AA artier cc o S <br /> 0 Meek ail S&rbc c. C04;1116115 PeZ 35 <br /> Fee Rec: �/6`Z' <br /> y Check#: f g 7 9 <br /> ( / J c <br /> Date t' <br /> of staff site visit:hb l ! ' I Initials of sii visit staff: A <br /> ( 94,44: i . <br /> `o <br /> APPROVED BY LAND SERVICES OFFICIAL: /r/L1 DATE:— =nPO <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z'sal T Of <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT §Gtr`s <br /> g <br /> 0 <br /> Transcendent: - Page 1 of 4 a# N Q <br /> Laserfische: Burnett County, WI Land Use Application—Rev 12/2020 g mliiiil <br />