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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> Applicant Complete All Sections Below This Line C c <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1 ! S <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1I J <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .• ice <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° G <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ', • "" -9 <br /> *NOTE:After-the-fact permits(permit squired 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. eo <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> /� <br /> (J3 <br /> } - <br /> Property Owner's Name: recj a V 4 �.1,, 's -- z <br /> 7 <br /> Property Owner's Mailing Address: ,74,-7 e (its ye''0 Cp�t v'1 R . r oo1 I <br /> P <br /> City State Zip $ <br /> Property Site Address: (544M64)` yi t.J1 $'���(�_ �' 7 <br /> Contact's Telephone Number: 7e 3 - )-} - 9 I/. - . <br /> Contact's Email: 'in°(1Y 't41l`1e'S e ex4-totk Ccs •w <br /> Legal Description of Property: Pt/le (RAI(' e.LsT y <br /> / o uo I <br /> #: <br /> Section#: (53 Town * .J N R #:ri 14o W Town eer' n C'Ic .. <br /> O Range pn ow <br /> *Attach additional page if needed for lengthy description OR attach a copy ofthe deed OR attach tax system property page.* CI <br /> • <br /> g. <br /> Tax ID#(1-5 digit number,found on ta�rrr:�i•nd•...ar� S Z �' i 1 <br /> Proposed Use of Structure/Addition: G c' Site C` (7. (,t J Feta•+'t. j I4itui t/ 4 I '' 'y I� <br /> Anticipated Start Date: ome/Cabin;Commercial Business;Bedroom:Deck;etc.) <br /> d <br /> Building Contractor: Sewer Installer: I— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ; i i".Z' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their LDC Inspector to determine if a permit is needed from them prior to I^ <br /> ANT construction taking place for any dwellings,die lung additions.manufactured homes,manufactured z ui <br /> home a lions.and hukhonse.l* S <br /> 10 l‘i dr r It glA /labs rbc <br /> �� Jie p/I( . ,1 efv1v 5 5I q- <br /> I/V5QeffitL pA 30 of) 40 �57b Qor vre- . FeeRec: <br /> M t'i l d Check#: <�sc�� <br /> I ( Lrn <br /> Date of staff site visit: 1 Li l '` Initials of:to visi sta' J. z <br /> Ali rn <br /> APPROVED BY LAND SERVICES OFFICIAL: / 111, <br /> DATE: < rUPON APPROVAL: APPLICAN / S POST COPY OF y c <br /> a co c Z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m CD <br /> Cud <br /> a) <br /> Transcendent: Page 1 of 4 m o <br /> Laserfische: Burnett County,WI Land Use Application-Rev 12/2020 m 3 <br /> 0 Dili] <br /> y .7. V. <br /> 9 ' 1 ' ' <br /> t l�J) <br />