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LAND USE PERMIT APPLICATION— Burnett County, WI a 2 b <br /> Applicant Complete All Sections Below This Line �' <br /> cn N <br /> Permit Types and Fees:(Please,check appropriate boxes) a. o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 b <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 0 0 <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(1y)Structures $350 ° . t/ <br /> Filling/Grading $150 Boathouse $500 r. p <br /> Six Month Camping Unit(One Per Year ° G n_ <br /> p g ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 , <br /> *NOTE:After-the-fact permits q begun)mayup `n 9- <br /> (permit aquired after construction has be un cost to three times the normal fee. = <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. Z <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> J� r _. <br /> 0 <br /> Property Owner's Name: J/C/v l S e /^ I'\f'e /SC�II ° z Q <br /> Property Owner's Mailing Address: 28'7.. 3 S� le F0441 �?-J a <br /> t ! City State Zip 00 <br /> Property Site Address: A I 5` {� / U C <br /> ,-rC =' <br /> - _ <br /> Contact's Telephone Number: 6 c p 2 70 - 2 ? oo y <br /> Contact's Email: c{ q! ene s c8 �° d1440,/ - 66 m °' <br /> ,/ <br /> //. -"<-;-: <br /> /�d 7/e 4/ f-4,,,,,,/, di, '-<- 4./ i , <br /> e <br /> Legal Description of Property: LI"if 34,;ST% .V3 7, t u y�o ye,- yr � <br /> Section#: // Town#: 4 t7 N Range#: /C W Town of: j v1 cA-J0g-i <br /> o ao <br /> *Attach additional page if needed for lengthy description OR attach�a copypyof the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): i? �co� C?-) ic:34 <br /> Proposed Use of Structure/Ad itio : 661✓'u 5 a' <br /> Anticipated Start Date: /40 ZZD 2 J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: 0Wf/jev- Sewer Installer: -I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY cic <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their CDC Inspector to determine if a permit is needed from them prior to O <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured home ,manufactured z <br /> home additions,and bunkhouses.** <br /> co ryi bine l©.s 3q " .S---. V/Iftk. C SIYI <br /> mac, /5?c a <br /> NO 1 r �� � i 'ba 2 Fee Rec. ''�a�• <br /> _ . <br /> K Check#: 0 <br /> Date of staff site visit:/i'e----/P---CP-OO� itials of site visit staff: $'i 1( <br /> / <br /> APPROVED BY LAND SERVICES OFFICI DATE: l - ' <br /> 7 �a <br /> • r <br /> r:'":4)0 [Fiji] <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF / ' ___,E___j=3 <br /> CD n 0 <br /> 1 ia <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o co Lri <br /> Transcendent: - Page 1 of 4 R ....= <br /> Q <br /> Laserfische: Burnett County, WI Land Use Application —Rev 6/2020 T 3 MI <br /> LC— 4.-.J <br />