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LAND USE PERMIT APPLICATION —Burnett County, WI a c <br /> b <br /> Applicant Complete All Sections Below This Line 0 N <br /> a �--' <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 „ 0X2, Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 .)•1g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 CD <br /> ,, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 an <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° . A <br /> Filling/Grading $150 Boathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> ID, v <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. °' <br /> I*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> Dan 4 'Bre, ,p�, �^�''ca,vd ° <br /> Property Owner's Name: o <br /> 150b '1O A)€• . ��3 Edam. IAN 55435 i <br /> Property Owner's Mailing Address: S <br /> y�,,� City State Zip -a <br /> Property Site Address: 49049 QOurit „OaA � �. •,� <br /> VVN <br /> ik <br /> Contact's Telephone Number: 10‘26-• 3�1 1161 Z . <br /> 11__ <br /> Q <br /> rrIl� <br /> Contact's Email: G• Q 9"^ •(DWI a <br /> d <br /> JJ 0 <br /> Legal Description of Property: <br /> N <br /> m <br /> Section#: Town#: 40 N Range#: 15 W Town of: �"a�.k$011 0. <br /> cm <br /> *Attach additional page if needed far lengthy description OR attach a copyof the deed OR attach tax system property page.* <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): SI,is <br /> Git v: <br /> Proposed Use of Structure/Additiop: .11p A -� Q <br /> Anticipated Start Date: NIA (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) ._) s.x <br /> o d <br /> Building Contractor: NIA Sewer Installer: Nick <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT' IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 IVO d d' d< 14`4140l 4,i+ } ll z Q V <br /> = Fee Rec: ro— <br /> r- <br /> Check#:jOjafr <br /> Date of staff site visit: J` 0/� 'r <br /> Initia . of ite visit staff: a <br /> z <br /> d <br /> .APPROVED BY LAND SERVICES OFFICIAL: /,' ,,/ . /////� DATE: 3/3C,/?-( <br /> // m co <br /> INfil <br /> UPON APPROVAL: APPLICANT UST POST COPY OF a N a <br /> �, m e <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° Nffi <br /> Transcendent: - Page 1 of 4 m 3 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 d �` <br /> CR <br /> .a <br /> a <br /> RI <br /> RI <br />