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LAND USE PERMIT APPLICATION -Burnett County, WI <br /> Applicant Complete All Sections Below This Line OT a <br /> a 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 P\i <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 r- <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r— g <br /> Property Owner's Name: ILA 4. 0- 1" 11. -e C l o r e- o (• <br /> Property Owner's Mailing Address: 4/ . ?S t")es fa•I w 4/ fh d t e.✓/QW MN v <br /> City State Zip <br /> Property Site Address: 3 o 2.-9.5' (.-41 4 t 11 t,v 6Ill,4 CL AM Rci N I <br /> Contact's Telephone Number: 4J--/ - 6, 'I Y d 4 3/ 657 -2,3 o --is-7 ' c e./ / •• Q <br /> e <br /> / <br /> Contact's Email: /'4'61 !n / 3 4-/li e j/>1 4, -c o &I <br /> Legal Description of Property: GJ !/85c---7tJ°L` 4- 1,0110 0 i C t) Nro <br /> 0 <br /> • <br /> Section#: Town#: '// N Range#: / ( W Town of: x/44 <br /> 5.-G aq <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): a / 9 4) <br /> w <br /> Proposed Use of Structure Addition: 0 A-1- h h ov Se 1J - x <br /> Anticipated Start Date: to `I_ A 4"1-I (Home,/Cabin:Commercial Business:Bedroom;Deck:etc.) (.1%) R E <br /> a"A C H <br /> Building Contractor:--TA c /moi ('r A Z e e Sewer Installer: �;g �,./.) Pi 61 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY E <br /> THIS PERMIT IS SUBJECT TO LL ONDITIONS LISTED BELOW: z U <br /> t �1'le�- All Se u� <br /> a Nee 16.010104e Qer�rk c 4 R reeinelt" "• V /hovel �j4�lho�6e ► 1 <br /> m1n �aO �' <br /> at ?et MU- 2.0-tog GAS i ?trrn'a" <br /> .., Fee Rec: '/67 <br /> 11x <br /> L y Check#: /46-90 <br /> 5/a5 /a- l� m <br /> Date of staff site visit: Initi sof 'te visi staff: r <br /> APPROVED BY LAND SERVICES OFFICIAL: / Z DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N <br /> seo o Guy <br /> Transcendent: - Page 1 of 4a c r....1-- < ro <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 <br /> 3 <br /> L <br />