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r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 6. <br /> Permit Types and Fees:(Please,check appropriate boxes) I <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 6— <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,.� <br /> - <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1-\ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 07 v <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> CA <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> MP <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 /> J-1- <br /> � <br /> n�, r g. <br /> Property Owner's Name: S 't�t(._ J r w h S o <br /> Property Owner's Mailing Address: 13 / t ' i?o h/ r SI- S�p I A N 5-3-/4,2 g <br /> ,�^ ity State Zip $ <br /> b ► t , <br /> Property Site Address: t t L4 k 2 c„ <br /> '7 <br /> Contact's Telephone Number: 17- / 2 2 '� o c <br /> Contact's Email: IAA 0, e (:)0 -t e f Q % ,4/-�O s Co 1" -tet— <br /> Legal Description of Property: r C 1 6 C 5 ,M V I P )_'5 7 <br /> 0 <br /> oc <br /> Section#: S 24 Town#: y I N Range#: S W Town of: w S S <br /> 5 <br /> °0 <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system properlyPa e.* <br /> q <br /> Tax ID#(1-5 digit number;found on tax statement): 2- I S5 7 ++ g <br /> Proposed Use of Structure/Addition: / 12 u i S P �JQ-f- G c t I C J'o L�1 A P C s L-a k` <br /> Anticipated Start Date: So N (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) k <br /> Building Contractor: < I C Sewer Installer: 9J a <br /> ••-!:..$) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C <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, dw, fling additions,manufactured homes,manufactured z <br /> home additions, and bunk ouses.** / <br /> 8tk?iLlb <br /> r5 do lo\- ca,„ o+1 be used 30 4�L4I S <br /> e, ood- .er✓►-f-�-. mss+ be I I (on-+ati e V <br /> r w Q (�! �.� zt <br /> 0.;. PIJ/B kch v."4,-1-e. WCt x Fee Rec: QLD <br /> 4 Check#: ( j f-/ <br /> 11/_ 0 <br /> Date of staff site visit: CV/)1 Initials o site visit staff: d'1 L z <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: ',>1. DATE: 6(IV?" ,:, <br /> < r <br /> ro <br /> UPON APPROVAL: APPLICAN 7_17 ST POST COPY OF a 103 C5 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z @ a <br /> Transcendent: Page 1 of 4 a);g N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < g <br /> v <br /> a <br /> E <br /> b <br />