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LAND USE PERMIT APPLICATION — Burnett County, WI _ro r <br /> a g <br /> <' b <br /> N N <br /> Applicant Complete All Sections Below This Line o' n �+ <br /> Permit Types and Fees:(Please,check appropriate boxes) _ °' (� <br /> p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w (} <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ‘!"'D(),Q lk•+ <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 eD <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> C1 i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 oIA <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cA <br /> il, 111 <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. <br /> E <br /> Property Owner's Name: i Z A %././ iii ', a z <br /> • /7 Wh.,s.4 �iJS/� ls�)-�' A/ .5so 0 <br /> Property Owner's Mailing Address: �/ o <br /> ,,/ / n State Zip -dProperty Site Address: 7 V i 33 59L OW'S 'l V O1 L4413 • 5. n <br /> Contact's Telephone Number: Wo 3- 000 Go`9/ - • F, <br /> 2- <br /> p <br /> Contact's Email: /. '"it"'A.041 /� i , A(Lir/ AO d � <br /> Legal Description of Property: /014/ ('.,`-i-// `/�''/77 'v c-v 9l`-',,-Q <br /> Section#: 3S Town#: y/ N Range#: /CO W Town of: G5Zt/! SSE. °O 4 <br /> 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O. <br /> Tax ID#(1-5 digit number;found on tax statement): 33 59 .o "-' <br /> Proposed Use of Structure/Addition: -I ,- <br /> Anticipated Start Date: Q/ f/p/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) K <br /> o C7 <br /> Building Contractor: d/0'AiCke/' Sewer Installer: '' ''" <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **Tlze applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY constructionmeektaking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home dditions,and bunkhouse ** ( T <br /> c,(11 S elb <br /> No More t 3 �� � ar�I43 o <br /> ire over !o 5,-e+ <br /> � <br /> �ry� s ,,�.re. or (ite....11;0,46 S • <br /> �/f1ecs 4 11-#114( 'n,fi 25" <br /> Fee Rec.. .2 <br /> Check#:5(A25.0 <br /> tri <br /> o ; <br /> I"? IcI L._ <br /> Date of staff site visit: Initials of site visit st. � l ��-' m wff <br /> APPROVED BY LAND SERVICES OFFICIAL: /00 „r <br /> DATE: 0/?/2- < a ›,- <br /> UPON APPROVAL: APPLICACiarz UST POST COPY OF l <br /> LSm <br /> v, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 0.. <br /> Transcendent: - Page 1 of 4 P m 3 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < " <br /> dGel <br /> C� <br /> ^0 <br />