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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI R <br /> y N <br /> Applicant Complete All Sections Below This Line o a -' <br /> Permit Types and Fees:(Please,check appropriate boxes) C ej <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 it .-- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `. N) <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �j q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � s_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 $ e1G� <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 /> v2 ,. <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. RO*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> t y. i . <br /> Property Owner's Name: 1\ti;t't EcJ I i}li'1A } z <br /> Property Owner's Mailing Address: Z. Th .J e Ct C kL. `L4I a \tf <br /> City State Zii <br /> Property Site Address: `) c'`'YY1e... -5L0('2 F- n <br /> Contact's Telephone Number: 66j- Lie)." i1.. %Cl <br /> (NE NG 41\ q5 • i <br /> Contact's Email: gvtbkke_c'i i)-1 14"1 V UP/\ 5 <br /> i t ) <br /> 7 <br /> 3 y g90 ) 7 eg Legal Description of Property: 2,04- I C-6 m I <br /> 9E7%7o o <br /> Section#: 3 2 Town#: yo N Range#: )6 W Town of: DA K r - a.. '- <br /> ar <br /> a' <br /> *Attach additional page if needed for lengthy description OR attach a copyof the deed OR attach tax system property Page.* a' <br /> Tax ID#(1-5 digit number;found on tax statement): .- , Z I 3. <br /> Proposed Use of Structure/Addition: - .)mac.\ et slab `n <br /> H <br /> Anticipated Start Date: 6----:S \ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o k <br /> 1 d <br /> Building Contractor: , 2.+4v; Sewer Installer: Vu <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t <br /> **Ike o csu'a lir cer ct their UDC'Iavectbr to bferwi�e if.pallid!'is medal fres dies prior I. <br /> Ad1G c crime��1�y rhiriiats, /uses z <br /> bowie ei ers,dImes** x' <br /> Nth_ h t4,414/'� bi 'oma <br /> ,�toek oil se4-b' d4 <br /> et <br /> g Fee Rec:+161 / <br /> pi Check feN <br /> / ill ^.AS It <br /> Date of staff site visit: �i W4 Initials of si visit s ff: / — <br /> 1///de)--1— <br /> t'l <br /> APPROVED BY LAND SERVICES OFFICIAL: PAL/A �� I ATE: rte '""` <br /> UPON APPROVAL: APPLICA ' ' ST POST COPY OF 1W , tJ1�1�( <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT1.T. ,' N11 <br /> Transcendent: - Page 1 of 4 11Z <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 M <br />