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' LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> Applicant Complete All Sections Below This Line o c o <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> C7 U <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .1.,,t, k) <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 C % p ^ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° v-� <br /> Filling/Grading $150 Boathouse $500 r• O <br /> 9 <br /> Six Month Camping Unit(One Per Year) $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. 1 <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, <br /> ,such as:pergolas,landscaping,etc. v <br /> Property Owner's Name: S � `-,--4 t A— <br /> p rtY l�tl; ",� << _ Iz <br /> ` o <br /> 1�34/ Afeeti.ii <br /> Pro a mOwners MailingAddress: 'S�f / l /K Gam -C ' y's-s-vCity State Zip 3 a, <br /> Property Site Address: ,.s"t 7 776, a41 Ci.rt Are.4> �• y <br /> Contact's Telephone Number: S / S—J-,. {eaer <br /> — /0 ', o y <br /> C-_ 1 0 <br /> a <br /> Contact's Email: g1ic C:0f /xA- 07 E1 l' re. <br /> Legal Description of Property: Pet z-4 i 790 ' cf= ,c,CL Aiiv s'C9/ zit /a. <br /> N b <br /> Section#: go Town#: 4 N Range#: J W Town of: lCU e,"r'' r 00 <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* G <br /> til <br /> Tax ID#(1-5 digit number;found on tax statement): /87,, 4 a' <br /> Proposed Use of Structure/Addition: s1 e f ti re h// e. rVI/i C6',,ye,,.i4 `r' <br /> Anticipated Start Date: ft)//12 6 2.0 me/Cabin;Commercial Business;Bedroom;Deck;etc.) a <br /> Building Contractor: £i i,q v- (. ,H,. 4/cfi0,, Sewer Installer: ^/JN/ <br /> H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <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 /> r _� 7y <br /> pet- <br /> v a( -ckvv\a..v� n <br /> g Fee Rec: 1.5(T:a <br /> 6 Check#:5649 <br /> l,,, <br /> Date of staff site visit: 7' t3 O� c9 Initial of site visit staff: MY---- <br /> t <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: CI Ir' 11�� ° o. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o <br /> -8 .z �t ("c <br /> Transcendent: - Page 1 of 4 M m r.....) G1 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 rz a <br /> d <br /> w <br />