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• LAND USE PERMIT APPLICATION— Burnett County, WI <br /> Applicant Complete All Sections Below This Line c' <br /> Permit Types and Fees:(Please,check appropriate boxes) n. ' <br /> r— <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> n CA <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o .) <br /> Filling/Grading $150 Boathouse $500 - U! <br /> in Unit(One Per Year ° <br /> Six Month Camping g ) $100 Permit Extension(1 Year Extension Allowed Once) $100 a. <br /> si <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 3"Er',Ewt f Per`L C C.K 0 Z' <br /> sy893 9 A . <br /> 77 <br /> Property Owner's Mailing Address: 7 17 S O4K Wood Phi Kwn-( WEbSs.r W.I' — <br /> c. <br /> 717 0�4 Kw r K City State Zip U ro <br /> Property Site Address: g cXzl Ph tA.4-1 °' <br /> Contact's Telephone Number: 7 6 3- a 4 a•' `l e 6 6 <br /> CD <br /> n. <br /> Contact's Email: JU'cm y per 1 CK 6 e&wy I .COM o <br /> CD <br /> Legal Description of Property: ll/E SE yr /V W.S aR 39- 16 <br /> Section#: a 9 Town#: 3 9 N Range#: 14 W Town of: /rt EF.vo xv °_ °0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> Tax ID#(1-5 digit number; found on tax statement): I'a 769 r, W <br /> Proposed Use of Structure/Addition: CAr ,ric R f+ /GA E 30=0` . S0.O <br /> Anticipated Start Date: -� <br /> p SVNt a►oa 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) , ! N � <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY iu <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions,and bunkhouses.** <br /> - Ka* cU1 � c dC S <br /> xl: ! "---- <br /> -Wo{- - Irw <br /> 1Nlk.MO \ . 1-�v.-hY <br /> z Fee Rec.. f 57$ <br /> 4 Check#: d f/- <br /> 0 <br /> Date of staff site visit: 5 12 * Initials of site visit staff: 1 z <br /> G� 2J -���� Z ° it 1] <br /> APPROVED BY LAND SERVICES OFFICIA DATE: `�� L'�L�J < MA aa)i <br /> rn <br /> UPON APPROVAL: APPLICANT UST POST COPY OF 4 N <br /> o0 <br /> m Vy <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,... <br /> Transcendent: _ Page 1 of 4 :pui .cc <br /> Laserfische: Burnett County, WI Land Use Application- Rev 6/2020 G `° <br /> v <br /> a <br /> 4 <br />