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LAND USE PERMIT APPLICATION- Burnett County, WI a `° r~ <br /> Applicant Complete All Sections Below This Line 5. <br /> CD I <br /> Permit Types and Fees:(Please,check appropriateboxes) a m _, <br /> Dwelling/Principal Structure $300 K, Addition/Alteration to Dwelling/Principal Structure $200 a <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 CD <br /> Accessory <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 4) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 r p 1 <br /> o , <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. p ` <br /> 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. -0L <br /> (� r g. <br /> Property Owner's Name: 1,1 vi i ((1., D r i L k Lc S o . • <br /> Property Owner's Mailing Address: \ \C 0 ir--[i-'( COO d LO k11 t S-S 7 i <br /> v �^ I C'ry State Zip $ r- <br /> Property Site Address: ( S CGl,�t r t `i- Lam)1 �S4e1rt LA,:)T <br /> Contact's Telephone Number: Lc E I - II ci (' Ce o <br /> 0. <br /> Contact's Email: Cl,n 1 .c r i 't LA S C ma- a. co re, d <br /> a, <br /> Legal Description of Property: Lot 1 e s ►y'1 ✓. / A' iJ --)s--) <br /> Section#: QS— Town#:4 O N Range#: C W Town of: 3—CZ C IC.SD Y) 0 ore <br /> ao <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa e.* <br /> P <br /> 5 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> J <br /> atement): �4 <br /> C 5. <br /> Proposed Use of Structure/Addition: t la I C "' <br /> Anticipated Start Date: ( I-<DU,D 4 (Home/Cabin; etc.) >4_ <br /> Commercial Business;Bedroom;Deck; <br /> 0 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: P _ 1 <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 O <br /> home additions,and bunkhouses.** PooW <br /> 05ee. u n4_ 2_/-/7 kvtu.e- icmvo ere icti,i^ Cc frfc:44.22"4-1,5 <br /> Df Va 1/1 q►it cee_ a P p rte Veil• <br /> J 6 c 6 oris Per` <br /> 3it /a2 � �sv� <br /> r�"� u e r ertx Fee Rec: CSP. <br /> cp,titr7 ,ai z e, —se f er ii/# 35/737 z <br /> O 4Check#: 8•17D <br /> r <br /> Date of staff site visit: 2/9/240 r--2—Initials of site visit staff: pi— Z ' r--1 <br /> o �r <br /> Iv <br /> APPROVED BY LAND SERVICES OFFICIAL. .:4-6"-": DATE: .9/512 Z <▪ o' V� u u l <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ca rn <br /> tri z <br /> -n r, m �. <br /> > CD5 = llul <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r A 0 N c <br /> NI <br /> Transcendent: - Page 1 of 4 P 3 <br /> Lase • che: - <br /> Burnett County,WI Land Use Application—Rev 12/2020 < w <br /> / M <br /> 0 Ae 1, Yew Tb Glave. a Nl MNa/Y1 A i r) y'cv r ram S,, <br />