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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line 'g' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 rwcl <br /> — E. <br /> CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I) <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 a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 C <br /> in Unit(One Per Year) <br /> 0 <br /> Six Month Camping g $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. <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 /> o • <br /> Property Owner's Name: �c y� 1 l c.)..L� cl\ CA— i^ \e 1 <br /> I 0 7... 0 LA e...-14-1",...v.,-: 44 S,_ <br /> Property Owner's Mailing Address: i�I Gc:,i..t i,,iS�vi) N <' y 2 c) <br /> o <br /> City State Zip <br /> 7. <br /> Property Site Address: ,� S `� j Sc c -` r� l9%r lJci s' l t S'- i 2� =. n <br /> E <br /> Contact's Telephone Number: iSj-^ S 7-LI.5 Ca < / <br /> o h <br /> • c <br /> /&- a. <br /> Contact's Email: A C 4i ( i 1.1v �,,,�,.,t L,, S , ii d <br /> i <br /> Legal Description of Property: L.e I s-6-5 S` cam- A rLi 1.1-:, •1 <br /> Section#: 33 Town#: 9 0 N Range#: I ip W Town of: O6� ti 7 <br /> h� J, b <br /> o 00 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> 7, <br /> Tax ID#(1-5 digit number; found on tax statement): I-i' '-'0 0 ••=,.. <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: /0^/), Z 0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f <br /> Building Contractor: 5 GPvvtc<v i •,v,113 C X . Sewer Installer: . 2 , 0 <br /> -3 lb _ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to t- d <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured z <br /> home additions, ad bunkhouses.** % ` ;u 11 <br /> OM l'Vt1/4-,'-\- 0 Pc9CAY-CATC <br /> . 5If-0- (90 -/ 7 S (6471-A;(0.7-tyl. ( va..y) <br /> Fee Rec: I <br /> U. <br /> � y Check#: g9QB <br /> Date of staff site visit: ` �� ^ �� Initials f site visit staff: PtY--� > - <br /> APPROVED BY LAND SERVICES OFFICIAL \(--C:37-1"...-1/4- DATE: <br /> A< E r <br /> flag, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W © <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° o o <br /> < cD C N <br /> Transcendent: Page 1 of 4 mK c <br /> Laserfische: <br /> - <br /> m Burnett County, WI Land Use Application— Rev 6/2020 7 <br /> .3•+ <br /> u <br /> cA <br /> . <br />