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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o � <br /> co <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) d w <br /> -• <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 VV <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �...c <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \- <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 5). oo'' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension Allowed Once) $100 = ,, <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. el <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o B <br /> Li <br /> \_ i 1111 <br /> Property Owner's Name: 0e�- Ani. n C\1,ty C) -n •o <br /> 0 1 <br /> Property Owner's Mailing Address: 35 i a 'beer er I ctgE RCI 1))Ylbc� ,1.4)1 5`/S-A7 $ <br /> 2 City tate Zip 5 n <br /> Property Site Address:3151 t,) 1� � la\4. Rd -O�� � t W t 5(- ki O E/ <br /> N <br /> Contact's Telephone Number: 1 ISS a)lU O13Li CCCa1 o a. (� <br /> p flCL`.C-..-°`-r)C-..-°`-r) C7 v <br /> Contact's Email: 1i(16:76(IurD1�eJ a <br /> Legal Description of Property:LOt 1 Cpm v 22 cR 0-39 y q-7 7 (I,p) )0t 3 / cMI <br /> L' = <br /> Section#: l2 Town#: L7 I N Range#: / 5 W Town of: SWI$SGo <br /> P <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> LI <br /> Tax ID#(1-5 digit number;found on tax statement): a I 3 I fc„ <br /> Con\-wyw e 9' w 1de y0' 1ensm sio c o <br /> / <br /> Proposed Use of Structure/A dit`ion: <br /> Anticipated Start Date: U t 2.0.2-1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 7 <br /> Building Contractor: "'el-- Sewer Installer:-Co.' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: lA '-C. <br /> ell AJo-1.- &b( Vk,it✓n 1 11"14-4Thic) 71 <br /> .- Fee Rec: <br /> 7' Check#: 221 L, <br /> /212-I l 5 <br /> Date of staff site visit:6 Initials o site visit staff: u(� y <br /> - /. , <br /> APPROVED BY LAND SERVICES OFFICIAL:lavA / / DATE:6/(3/2./ <br /> UPON APPROVAL: APPLICANT Nil <br /> UST POST COPY OF • in <br /> y a > <br /> -Im� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -, mIiiiil <br /> • y n --I <br /> rN 0 PO C.7 <br /> Transcendent: - Page 1 of 4 m � <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/2019 < (U1i <br /> C CCcna <br /> g <br /> -o <br />