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LAND USE PERMIT APPLICATION—Burnett County, WI a g <br /> 0 c N <br /> Applicant Complete All Sections Below This Line °' 0-, <br /> P. <br /> Permit Types and Fees:(Please,check appropriate boxes) ' . 4)'d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 r i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �} 9, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< �,..0) 1kFilling/Grading $150 Boathouse $500 o Gjw 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ill �, <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. "mom <br /> g.' r. <br /> Property Owner's Name: -. e_fry ` . c-w,c'\ C>f`\ � o i• <br /> Property Owner's Mailing Address: '.--)ld;C; Lp 0..k t ,,,,n Z C tr, S4yt3 C; 0,14 c5-0 °o <br /> Citi State Zip ° ii <br /> Property Site Address:j(0 a-, -S ©S\'trif t) we- kr--ef W-1- S_`/8 13 I rn <br /> n <br /> 4 <br /> Contact's Telephone Number: 6, (- 'VI 1-OS 7U • r <br /> �, a i <br /> Contact's Email:S e;-e,My C,.0 G r-c.6j ca.! pc;I\I.r,=) s ZTv:ca i. C-Li d <br /> coV <br /> n <br /> Legal Description of Property: Pcjf'C 1 .±. b <br /> N b <br /> Section#: IL] Town#: .3°I N Range#: I 1 W Town of:t k;zh' A.t' ( y‘L:.)f n) 5CM. <br /> *Attach additional page ifneeded or lengthy description OR attach a copyofthe deed OR attach tax system property page.** o0 <br /> P S f S Y P Y P P t1P8 0 <br /> H <br /> 5'. <br /> Tax ID#(1-5 digit number;found on tax statement): /c to G <br /> Proposed Use of Structure/Addition: S2}:.c-go)e_ `r' „� y <br /> Anticipated Start Date: --7j-i/v\Z minty (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 fie' <br /> d <br /> Building Contractor: t,UrN,\Itizr c tn;1 C..:' ( Sewer Installer: ,v /,1 y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY D o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to SN <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured Z <br /> home additions,and bunkhouses.** Po <br /> leek- j S <br /> 0 rV off— k-e)( i,A,140 Iii. -4-CS <br /> cs over 100 ' "tib' c,� oe �j Vl e.1 ,c, <br /> ` Fee Rec: /5 O <br /> n�S �� b 4-k rnob ems► recti . 0 <br /> 0 L'' � � � � � � Check#: ��� <br /> 3l LJ I a'c L <br /> Date of staff site visit• " Initials of site vis' st ff• <br /> r 8 <br /> APPROVED BY LAND SERVICES OFFICIAL: 111. ., yr. <br /> _.-:„../.4 DATE: ?- <br /> r <br /> RI <br /> UPON APPROVAL: APPLICAN / UST POST COPY OF r 1 CO f. 0. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0s 0 N <br /> '< 0 0 <br /> Transcendent: Page 1 of 4 n 5.,3 CD <br /> I's.) <br /> Q <br /> Burnett County,WI Land Use Application—Rev 12/2020 W <br /> Laserfische: - o gill <br />