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LAND USE PERMIT APPLICATION - Burnett County, WI cr 0 <br /> a, N <br /> Applicant Complete All Sections Below This Line a' C <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d t, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `",-._--.1 <br /> Accessory Structure(Garage,Shed,etc.) $150 ,Addition/Alteration to Accessory Structure $150 .cO <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ky0, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' ,, <br /> o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 <br /> r <br /> o <br /> Six Month Camping Unit(One Per Year)) $100 Permit Extension(1 Year Extension-Allowed Once) $100cn ` ' <br /> *NOTE:After-the-fact permits(permit aqui red 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. -o <br /> 4.--/Ki <br /> o g --Property Owner's Name: C/1?i /t'S a" L t et f`/s z 77 <br /> P ,,, <br /> Property Owner's Mailing Address: 2-`716—S-- 13131/1 2i f'— J� C 4 - t'' 1114'- LV/ --CY/A if-1 ,,, <br /> City 'tate Zip $ <br /> Property Site Address: Sam <br /> C7 <br /> �, <br /> Contact's Telephone Number: 6j/— <br /> vs .(5-3 �-5o <br /> h <br /> Contact's Email: C 4()I- /S 4yi ova 4,0,C c, 7... ... <br /> w_. a7,1 <br /> Legal Description of Property: L i' +/ (S 11l"ir L c,I a j e 1Y 2 l9v'e t li L -2"' <br /> N 'C <br /> 4 J <br /> Section#: Town#: / 0 N Range#: `7 W Town of: S ( i rt o w <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): 7 9-rr 2 y j4 3 Z <br /> Proposed Use of Structure/Addition: s )ve ;e C? C0✓ff r',2 J/i Al c)) ( lr 1'4:1<e-r r" <br /> Anticipated Start Date: "11,4'/IP / (Home/Cabin;Commercial Business;Bed►dom;Deck;etc.) / !CS2) .--i <br /> x <br /> Building Contractor: I �1, Sewer Installer: �fA e <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 0 <br /> home additions,and bunkhouses.** Pzi <br /> Nrl e&f a 11 Se i5 <br /> No+ -6( htiesut^ h4 b'•L ,4-`cA <br /> 0 1 2.5 is -{ice 0,11:.Wdelf Q b oV c etv <br /> V•e ©�►1 ) No V a rts;G ., q 0o <br /> z Fee Rec:r1 <br /> +OW%friS 1311:77:e o Check#: cerIJ, <br /> Qvt <br /> Date of staff site visit: 9 I?/A-I Initials of :ite vstag _ .....7 z ' ( _JD <br /> APPROVED BY LAND SERVICES OFFICIAL: IPA / ,- DATE: 11/15/9/ i O <br /> -UPON APPROVAL: APPLIC A k.. . MUST POST COPY OFlic , <br /> `n G <br /> il <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTis) <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 P. �� JJ <br /> fi <br /> 0 <br /> M <br /> a <br /> 3 <br /> -a <br />