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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line oN <br /> r ~ <br /> Permit Types and Fees:(Please,check appropriate boxes) O w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 E k) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> '),‹ Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 v <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� \ o <br /> \ V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° a <br /> Filling/Grading $150 Boathouse $500 0 I <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) _$100 O <br /> tic <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = ek <br /> ES <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: iJitI C r a \ i CiIU`Yl o <br /> Property Owner's Mailing Address: (D 93 O t)I,0 2.cA(0 O`er .,_7 i) )c /) LUr ° <br /> / City tate Zip <br /> Property Site Address: �I�tJJJZ Com,( �,GUU� i 9£`7)G111 <br /> lbc <br /> Contact's Telephone Number: /5o� -363- r.Z /7 <br /> . 0 <br /> CD <br /> `^ C <br /> Contact's Email: QIQG6/CSA, / d/aidC4/yohio, CCY�J GLo <br /> =� <br /> Legal Description of Property: N 3 03' Cj� L�S <br /> 0 oo <br /> Section#: 3 5 Town#: 4 1 N Range#: I, 6 W Town of: SW( 5.__S = <br /> 5. <br /> ac <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system propertypage.* <br /> 0. <br /> F. <br /> Tax ID#(1-5 digit number;found on tax <br /> statement): 2 2 31-/ v- <br /> Proposed Use of Structur /Addition: 6.4.✓'� G 2 `� <br /> Anticipated Start Date:caf tcur XL( J �(1T� ) ° <br /> ome/Cabin;Commercial Business;Bedroom;Deck;etc. x <br /> ] ° d <br /> Building Contractor: fi(,)/ )/Q/Jd ii'ib%y S Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E <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 W <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bu houses.** z .......„ <br /> il 01 e4 e 5t-� c15 <br /> (0 -- c_c0( lit K 4 rl 1/1.4.1);- )1 <br /> rn She l-}- 1Scr✓ti <br /> tip .L.�e� `�l'`�' use P� '� � al' <br /> d <br /> V 5///)/ i Fee Rec: L5tP <br /> be ke .1- 0. ( A r4 e. 00/15 Y+oci or) - Check#:Cf bf <br /> P � �9' o <br /> l. 2 Initials s/ site vis't staff: ()` m <br /> Z r <br /> Date of staff site visit: �� o <br /> APPROVED BY LAND SERVICES OFFICIAL: , '", DATE: la/114/ al _ i p <br /> UPON APPROVAL: APPLIC • MUST POST COPY OF n ` in C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° ii <br /> Transcendent: - Page 1 of 4 n 1 <br /> #' <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 a <br /> rri <br /> 1— <br /> i <br /> b <br />