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LAND USE PERMIT APPLICATION— Burnett County, WI c <br /> r <br /> Applicant Complete All Sections Below This Line 6 o <br /> CD <br /> , <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> ' Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d r"-- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `, Q <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,,O <br /> X, Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G-' <br /> X, Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 r. N <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 00 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. = _i <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: /9/R.4C. 49/,e/ G /r}- �' 4/ 3 21 y o o <br /> Property Owner's Mailing Address: ,2-ea /77/0/)0A,//)&4f G)0/e/I) 44/45 4/ ,..1,-d..5.:3.,/ o <br /> City State Zip <br /> Property Site Address: 37 j5 "-/2s A90 Am/ eii.y.,� ‘41-7E• <br /> ET:I k <br /> Contact's Telephone Number: 7/ ).1—, 9Q (v 7 C/�41 G�yr� /rU"c7iz:-.8-) o <br /> Contact's Email: 67s.-.,.v //1/:71--:yf::49 (�L/'/i K.e_A/1/6 514/0 I✓Vlv ,.E,L f'!c-rc 5 r c et77 l o <br /> n w <br /> Legal Description of Property: /We.r_/ / (' S✓l 1 0 Co P e'`'/ (/,y 6c U 4-7- ) .. <br /> / N -u <br /> Section#: / Town#:7-- C) N Range#: /Q/5 W Town of: ^/ KSC�l 0 00 <br /> cm <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> C). <br /> Tax ID#(1-5 digit number; found on tax statement): '7 ry 4/ <br /> Proposed Use of Structure/Addition: /4-4',65c.,4-p(,i/6i T i4)A--1.-(. jf pi g `n <br /> Anticipated Start Date: /6 — )2 9— a-t1:2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) /1/raZ'/ o x <br /> 5. <br /> Building Contractor: Se9e4ti/'{,rbc Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured Z <br /> home ad 'tions, and bunkhouses.** <br /> - 7 J$ prrr — ^5 -or r�lacth5 e-P575 <br /> 3 rte- \�m t�c.k5 Q +ke QX l S`'{' ren <br /> 7.- K Fee Rec: �/he - cc-- S et1— W/iZ � 4 <br /> Check#: Vit.K <br /> AVc <br /> � CD <br /> . <br /> Date of staff site visit: i i AP,.- I a1s of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICI A : t - DATE:/Or—c3.272-A2-01 `- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF F� 3 n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 a <br /> Q <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: OW <br /> Burnett County, WI Land Use Application– Rev 6/2020 `` <br /> �L <br /> 3 <br />