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b r <br /> LAND USE PERMIT APPLICATION -Burnett County, WI a g <br /> • Applicant Complete All Sections Below This Line 0 o <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> .....j <br /> )(Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d Gj <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 \ O <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(1v)Structures $350 T <br /> Filling/Grading $150 Boathouse $500 r <br /> in Unit(One Per Year) t <br /> Six Month Camping g $100 Permit Extension(1 Year Extension-Allowed Once) $100 tt <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. s <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ,C <br /> - jj � r.-. • t% <br /> /nk <br /> Property Owner's Name: G` 7 k.,___ lT <br /> J-- -r_ //�((c ° <br /> Property Owner's Mailing Address: 7 !� / `( k 10,0,..((-c7, �t�- � s��/ t.,' <br /> a CD <br /> / City State sProperty Site Address: 5-0 (l-00. - 5 K.7 p..o c, a 5 5-tvie2. N <br /> Contact's Telephone Number: 6(Z _ ..- 4/ - 47 "7 7---E `� o <br /> 0 <br /> Contact's Email: -� _, d✓. �`��t co,...,_, <br /> d <br /> ICD <br /> M <br /> Legal Description of Property: + 1( (ii kvk VS P I't`' 0-2.o,-(0.54. <br /> Section#: 7":43 Town#: Q I Z N Range#: /0 z `'C° W Town of: cr e--1,2-6.'-^ 'f° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t. N; <br /> c 8. ��' <br /> Tax ID#(1-5 digit number;found on tax statement): s( 1 <br /> Proposed Use of /°6 <br /> Structure/Addition:// V Ow {-7G ,"• cn <br /> Anticipated Start Date: if 1(7-62CJ (Home/Cabin;Commercial Business;Bedroom; <br /> Deck;etc.) I <br /> p <br /> Building Contractor: L( CSA �`7 (e--- L-t ( <br /> ' wer Installer: /1&'J h '—S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY n 1 <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 /> ----- 0 R 140 tA,Se.- <br /> -------:: F; II-C e/0-71— ("f rsi21Clf COC;f--c)-g-l') o) <br /> 1 5.73 <br /> Fee Rec:32fJ <br /> Pti <br /> 4 Check#: 39?-7 <br /> , <br /> r 3 Z _ <br /> Date of staff site visit:/0 /"'"-- -c), 0 Initials of site visit staff: � � <br /> APPROVED BY LAND SERVICES OFFICIAL: BATE: /� �3/W Z,O <br /> Eijic <br /> tz <br /> F a Cl <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF : < �' CS? <br /> a - <br /> N y N ffifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 0 <br /> Transcendent: - Page 1 of 4 g �` c"`'—r <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 2 Nn1 <br /> a L�) <br />