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• LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line S o <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> 0 <br /> ',`Q Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v <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 , <br /> R. <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 V <br /> \ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `;� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Tr <br /> Filling/Grading $150 Boathouse $500 C r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> svc4 i <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. V Pv"- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: • <br /> 0 <br /> Property Owner's Mailing Address: igoi 5 SK 11 i hi fc<G Wthau IAA 5=48'4_5ET <br /> 0 1 <br /> City State Zip -0 <br /> Property Site Address: Y'j CtS ,bCvt. cA <br /> Contact's Telephone Number: I tS'�3'"1- t ce')e 0 , <br /> a. <br /> Contact's Email: on('L'�Q; l'�.@ l .rne r,c; r,(\U(()\ 2 JI1A�111/t c •tom d <br /> Legal Description of Property: ©1 "a \ U9 25o 3500 tt <br /> o o <br /> Section#: ,,� Town#: 110 N Range#: f�I,� W Town of: 3-c��X0(. D c <br /> ro <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g <br /> a <br /> $335 <br /> Tax ID#(1-5 digit number; found on tax statement): .„, <br /> Proposed Use of Structure/Addition: \Awe, cA <br /> Anticipated Start Date: I 1 / 1 / Za (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> Building Contractor: uexstc\ \r 'IPi�� Sewer Installer:Re�'Qr�iCC4( j m nc) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A GI <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 N �1 <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes,m, i r ct r•! z g <br /> home additions,and bunkhouses.** <br /> =d Comb n.e I r\--5 c3 S -\- l0+;(Q Via CS w\ LY 4( <br /> _--P. yli't,51/4( is -Po filV)6 b-Coa (am€� See `t-i' j vi--. <br /> ,_-_17.7 iio rn e m t 1 b e R nnod ctr hovri e ,b,,,,-,1_,A__--F, Lk c- . -a✓-- S <br /> Fee Rec: _DO <br /> F Check#: 10 <br /> 0 <br /> Date of staff site visit: / --d 7---,9-0� r Initials of site visit staff:1 A - r <br /> APPROVED BY LAND SERVICES OFFICI' : , l ATE: < a7A"r )09) - E <br /> CDUPON APPROVAL: APPLICANT MUST POST COPY OFCD CD 3 <br /> CD _ Tifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' o N <br /> Transcendent: - Page 1 of 4 - �" o <br /> Laserfische: Burnett County, WI Land Use Application —Rev 6/2020 - _ �U <br /> i <br /> L .J <br />