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LAND USE PERMIT APPLICATION- Burnett County, WI b <br /> Applicant Complete All Sections Below This Line g c o <br /> Permit Types and Fees:(Please,check appropriate boxes) \ o. 4 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d eC <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 d <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 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(1v)Structures $350 o <br /> (Ci <br /> Filling/Grading $150 Boathouse $500 r- <br /> Six Month Camping Unit(One Per Year ° <br /> p� 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. w <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, g:'(landscaping,etc. <br /> Property Owner's Name: C") 'e i'C L 11C-k�' SC L., i,P AI l- '1-- ° II <br /> z ' <br /> JJ l'. O • <br /> Property Owner's Mailing Address: 10 i Lti 44-' A +A-z `�C /14,r?I'te51'; i', ,tf �,/ 5 `f/7 <br /> E. <br /> ,,�� City State Zip <br /> Property Site Address: i32 7 5 LA.)::( /(JC 2'Ct 7 C? `5 >Y-e Pi (A)J 5 cr,S' 7.? g. 1 <br /> Contact's Telephone Number: 7/5 - 7 C7/ " Lc 76, Zy <br /> �� a <br /> Contact's Email: 5(t,Y�)►'Y!In i l: ( ;,'ii c t /. co i-„, , o 3 <br /> / 32 G <br /> Legal Description of Property: (P ff I 30 /� ' `9 <br /> N <br /> m , <br /> 5 <br /> Section#: 17 Town#: 3g N Range#: 17 W Town of: Dept I'd S <br /> ' <br /> *Attach additional page i neededfor lengthy description OR attach a copyofthe deed OR attach tax °O <br /> p 8 .f S y P system property page.* C7 <br /> Tax ID#(1-5 digit number;found on tax statement): GLV 71f 0' <br /> Proposed Use of Structure/Addition:`` I'll('11 ;l t Ht, 4-q Jo f f r t f v) <br /> , <br /> Anticipated Start Date: /W (Home/Cabin;inCommercialOM_ Bu�sine s Bgd htBelec`)AJPP Z £ w <br /> Building Contractor: 'V A sewe Installer: ._,%1,` .I / �fi*rV t ` ` O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 5 <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.** / / z <br /> -p Ned 4 haver io /G�a/ii IIi154//mole S "'VI/0 /AN,E <br /> l►'Is by 12./isJ2ezo <br /> -4 Alexi/4 oblrl'h /Alod use perm 1Y- •Gws simile- co H1-44cr by <br /> I ZII/SIZ�OW / / L x Fee Rec: ______ <br /> V u'UGfe$ h er a// W eo 4 de U se-Was as S/frM J^e.'leve.. S,yM$!� 4 Check#: 14'Y <br /> 2/7- <br /> S <br /> Date of staff site visit: ( I/ /7/ZD Initials of site visit staff: /`s 20 W z <br /> ril APPROVED BY LAND SERVICES OFFICIAL: _ DATE: ////9/ZD 2e2 ? '' ' <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF cW <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT l3 a o N l <br /> Transcendent: Page 1 of 4 rt .- <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 6/2020 c <br /> I ifia <br />