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LAND USE PERMIT APPLICATION —Burnett County, WI 7 il <br /> z b <br /> r <br /> Applicant Complete All Sections Below This Line - <br /> Permit Types and Fees:(Please,check appropriate boxes) e 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 (� <br /> mmercial/Industrial Structure $300 addition/Alteration to Commercial/Industrial Structure $200 V �� <br /> Accessory Structure(Garage,Shed,etc.) $150 V Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c , <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 k <br /> rn <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. ,5 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -,c <br /> Property Owner's Name: V. '2t-\ WC)A\I---\R_C 1I , z <br /> Property Owner's Mailing Address:2: '4 2 Il CCc. \ (-)fJ U t'L V'U • 541 '3h <br /> Cit State Zip <br /> Property Site Address: SC% \Q.- im <br /> Contact's Telephone Number: 2-Ab 5 \5 L\' <br /> Contact's Email: UJ Y-VV(-,V, l `k , V Y o,\� <br /> t C 1,02,0,‘ <br /> L <br /> Leal Description of Property: /e.�L ( �a '� PCL 5 i CL04- {,� Q 1 <br /> Section#: It Town#: LI t/ N Range#: L 6 W Town of: OC1IS\C h &�J N <br /> n= <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> 1 <br /> Tax ID#(1-5 digit number;found on tax stat ment): 1318 F' <br /> Proposed Use of StructurelAdclrt4 ton: 0.ra,¢- <br /> eJt"11 <Ivo —i -3 <br /> Anticipated Start Date: es bla S (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) c x 0 <br /> Building Contractor:--------' Sewer Installer: d � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �J� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C1_ <br /> 0 N k'4114? k 4 6WC'7 ,Z <br /> x <br /> m <br /> Fee Rec: 5b" <br /> - Check#: a a <br /> Date of staff site visit: 5149'5/)-1 _ Initials • 'site visit staff: L_ <br /> -/- 2L(0) <br /> APPROVED BY LAND SERVICES OFFICIAL: , �� <br /> DATE:594 / F X <br /> nil <br /> UPON APPROVAL: APPLICAN `7/ UST POST COPY OFtO <br /> -1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT E- - <br /> ki <br /> Transcendent: - Page 1 of 4 '17..'l <br /> Burnett County,WI Land Use Application—Rev 12/2020 ' <br /> Laserfische: <br /> v <br />