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W r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ?. <br /> LI <br /> 'Permit Types and Fees:(Please,check appropriate boxes) D <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '' ,,Q <br /> Commercial/Industrial Structure $300_ Addition/Alteration to Commercial/Industrial Structure $200 <br /> )C Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �' h <br /> I Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 - <br /> o� <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) �' <br /> $100 Permit Extension(1 Year Extension Allowed Once) $100 , <br /> 0 <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. R14 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- 3 <br /> 0 <br /> Property Owner's Name: 16u ('el1Ce' .ieael lie le -r I° R <br /> Property Owner's Mailing Address: 3-3 1.6 W -7--)a H pg. '`A I J o l�.� n2/v 5533 TT n t <br /> 0 i <br /> u City State Zip <br /> Property Site Address: 3a 1 cb �{j(•c)Q r RA 5(a3co6 dor�1 �'.t <br /> C <br /> Contact's Telephone Number: d i t7c, /3q 1 -� 01I�j�'1 . a <br /> Contact's Email: Z-"R) )a( ( 1 C 9 rr c11( e L`Gm s' <br /> Legal Description of Property: t L• \ ,,,, cr L `t c.- S N ,ro <br /> L <br /> 5. <br /> Section#: , 3 Town#:V-` N Range#: /(, W Town of: ,c s S <br /> p <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number; found on tax statement): 2 1 S S. 7 <br /> Proposed Use of Structure/Addition: 1 err) Go�'Uc l J �t'.C,k 5 TA 1 pSTC l�Cm F- z x <br /> Anticipated Start Date: b <br /> p }9 pr :)) (Home/Cab ;Commercial Business:Bedroom:Deck:etc.) = C7 <br /> Building Contractor: 10l'S(c) 1514') ROO) S Sewer Installer: -4' I/)5 cnyQA -tre/L0/ V, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: • <br /> . t <br /> IMS- all I, • z <br /> pod- ear, Loc 441 <br /> Cam per n 1-4&6 GU? ,& i' a- or) �- ► 1 )od v - 1''b <br /> x Fee Rec:5?_d — <br /> NACI(2�C3�� 7 Check#: <br /> 6 <br /> Date of staff site visit: 3J ' —I Initials � .ite visit staff: ,. a <br /> z <br /> g401/ tA <br /> APPROVED BY LAND SERVICES OFFICIAL: di) ''../." r DATE: 71 <br /> x n <br /> UPON APPROVAL: APPLIC m i+"i' <br /> MUST POST COPY OF `4 g� 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o g <br /> 00 <br /> r .A 11111 <br /> S'O O <br /> Transcendent: - Page 1 of 4 m P n- Q <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 < m <br /> iiiil <br /> m a <br /> o �a \ <br /> -I <br />