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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> a. ' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> CD <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 N,, <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> Filling/Grading $150 Boathouse $500 - 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> r I*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. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: p Q v al 4;1 fr—ose r <br /> ( - o <br /> o' <br /> Property Owner's Mailing Address: ? 5c-1 b I--cy(_ 61.0c 1 W y c)yAirvaI M i'1 STU�j.2 <br /> n City State Zip -o <br /> Property Site Address: X XX -etk wC A ��C 1�IAirt. -'t S4Ji 5s) �U` PCzr�s�( ,-; <br /> J La i A <br /> Contact's Telephone Number: (.p L — 39 (p — '9 c� o N <br /> 1 • a <br /> Contact's Email: Ckc {3 i,2-ca) 3rb-..ai 1 , c p --- o <br /> ro <br /> Legal Description of Property: K)1,0 , .-v of S(' e�Vptl%C4/ <br /> 1, o uo <br /> Section#: I.,P Town#: ( N Range#: Ito W Town of: S iJv►SS <br /> s- <br /> °O*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* <br /> p <br /> Tax ID#(1-5 digit number;found on tax statement): a( $3. <br /> Proposed Use of Structure/Addition: � >� °5E) ' <br /> Anticipated Start Date: CI\el?t: '-' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C:, i E <br /> Building Contractor: �.r yy ,,, S-I2e_( CaerRAS. Sewer Installer: Q 1 d <br /> . i 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYE CA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .— ' W <br /> `*The applicant needs to contact their I D( lnspeeior to determine if a permit is needed front then:prior to tP <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home additions, and bunkhouses.** z <br /> QNod- t../ kv.vi It-tc,b:M.04 <br /> xFee Rec: ( J <br /> a <br /> Date of staff site visit: ?/f / a ( In' '.Is site sits .'f: ) ,11, . Check#:8( ! 2- <br /> D <br /> APPROVED BY LAND SERVICES OFFICIAL: V // DATE: ////pl/ <br /> UPON APPROVAL: APPLICA ' "►- UST POST COPY OF . z.3 �' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° m g N <br /> CI <br /> Transcendent: - Page 1 of 4 - 3 <br /> Laserfische; - Burnett County, WI Land Use Application—Rev 12/2020 , 3 _ Ifig <br />