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. LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line a ti l <br /> 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> CD <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 d I <br /> Filling/Grading $150 Boathouse $500 r- <br /> o ,-- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired 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. <br /> r @ 1 <br /> Property Owner's Name: ,-gt.i( et- L jjcy rC„ S+ to ss o , <br /> Property Owner's Mailing Address: -1 i7 7 - - -G. LC.. . !Ja d y (fogy ' - mit) -5--q"--) <br /> 29 Xse� City State Zip <br /> Property Site Address: )C,<x. CCC(To v(✓ . , <br /> Contact's Telephone Number: (0 12-1q 1- 5--)(4,1 o• F,'- 'C,i i"rc C•fe'r '`� n <br /> Contact's Email: 1)4:0, i©3pn.,\19 e Cirri/ -0P"I rift,10 f<:i e cp(k VCki 66' '• G d 1 <br /> to i7. -2-ryp-'-.34"2 a It <br /> Legal Description of Property:Gov t-ct 3 — <br /> Section#: i( Town#: 40 N Range#: o JL W Town of: 06,k,(,,,,,104 <br /> n <br /> cm <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number; found on tax statement): 1,314, I ' <br /> Proposed Use of Structure/Addition: L/&tr rO,,icl C-4' ' <br /> Anticipated Start Date: 21 v(v• IS-U.. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor�j e c r L Iii (Ie t j kr, C.-41/1.5 ILC Sewer Installer:Otk 14 dS.stMoj AN .pki(, <br /> ,.flte <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY cJ rel <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspectorto determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** m k <br /> f111 ec-F .,11 5€44 <br /> p• ell; vtoi- -iv CXCeed 3 bec�i 5 of 5/0J-21-34s <br /> pc Ow+ be ci e / I�� ?? i-k los <br /> n__ / O z Fee Rec:LAJO <br /> elp Aci (P55 IQPPP��� �f 1//2 o Check#:bl?+ <br /> Date of staff site visit: .5/31/� (� Initials o site visit •t. : '/ rri <br /> a � �'� � <br /> A /- <40" o <br /> � CA r- <br /> APPROVED BY LAND SERVICES OFFICIAL: tai , DATE:6`0 a < = M <br /> tnco .© <br /> K tz co <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF v' g <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' ts a <br /> Transcendent: - Page 1 of 4MI <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 12/2020 f , J� <br /> a <br /> K <br /> -0 <br />