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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a <br /> Z. <br /> Applicant Complete All Sections Below This Line ' G ; <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> a, t7 <br /> X Dwelling/Principal Structure /$300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) t$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 /> ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e b <br /> Filling/Grading $150 Boathouse $500 • a <br /> r � <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 0 = ir <br /> v) <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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 /> Property Owner's Name: 1 i <br /> p NC�dC� C�,E'Y���f'� o <br /> Property Owner's Mailing Address: AS SO e a'RfQ UR) bkliNsQ,11 le, H 14 .553'OC a <br /> City State Zip o •--- <br /> Property Site Address:U9�Ll 1O" \)T__)3)m\\ - ., 0 . ;;) (5G g <br /> �jContact's Telephone Number: �?�— `, ,'A'- 6�'0 o N i <br /> Contact's Email: ('_t', VI 0\ t,,_,L 'r (31\000, ( '0 l d <br /> el0 <br /> Fi <br /> CD <br /> Legal Description of Property 3-c \ U(„t p u A. (� t_ \J03 c ,i'j� �/ l(I CSE I�`, <br /> .„ . <br /> Section#: Town#: Li N Range#: W Town of: X 5 °C <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* °C' <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): 21 L3 <br /> s'-', <br /> J l� <br /> Proposed Use of Structure/Addition: D�;��� kl' I S y-le. x <br /> P � � / S� o � �n111')�'3h�VnT G <br /> Anticipated Start Date: glome/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: Sewer Installer: o <br /> H N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY k J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: J- W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to p <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z P <br /> home additions and bunkhouses.** T� <br /> (O OM' all 5c--ba cikts -) �y ail i'`V-}s o--- j Jet 14' D <br /> d O t4e,hi '4o ek&eeci 11 beds 'tee 54/1/ 1- 160 <br /> 0 C.9.11 +6, be CidficgocmP er be , i ne .6.. .)'''''-°- <br /> Fee Rec:� <br /> Check#: 44 <br /> 0 <br /> L m <br /> Date of staff site visit: 6 l�( Vl2 Initials of site v'sit st. r' <br /> /- ' ,Or <br /> / Ir, C3 <br /> APPROVED BY LAND SERVICES OFFICIAL: �• ,-- - 6 I(21/� w0. < (� <br /> �. i l 4024 / DATE: < <br /> UPON APPROVAL: APPLICAN UST POST COPY OF 1 --c 0 <br /> ,....., RI <br /> a, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o� Q <br /> I) rcs61 <br /> w7 <br /> Transcendent: - Page 1 of 4 3m <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < I!uu <br /> % <br />