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LAND USE PERMIT APPLICATION-Burnett County, WI a <br /> con 14 <br /> Applicant Complete All Sections Below This Line g <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) R. <br /> 'i Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `.r�y <br /> Accessory Structure(Garage,Shed,etc) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 eQ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ° <br /> C.— <br /> Filling/Grading $150 Boathouse $500 K <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> xn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc ' 1. <br /> Property Owner's Name: 2;1 Ca(Le_LA tSe, A-1\11914C.,/NE, - - t e_17 - KLA ksia9 F z <br /> Property Owner's Mailing Address: /58/ t*I /fj712S pot 5p ooA/Ei21 5-450 / ,�'o j <br /> City f State Zip - r <br /> 71 <br /> Property Site Address:a$ 5 c k G�Z I t.. aL 5�ooa't/ ) iN-1 Si!So/ .fh- <br /> 7 •' <br /> (�5/ -lies <br /> Contact's Telephone Number: — 99 7 A � o I i•-• <br /> Contact's Email: j jV1 AnIG,/IJrc, enc 1IITt,(.21�'TEL• ,J'Z-T <br /> • a.b <br /> 0 <br /> Legal Description of Property: ,,,-.... ) <br /> i o w <br /> Section#: s'i(4 Town#: 'fib I) N Range#: W Town of: Sed T7.- <br /> _ '� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 0 <br /> Tax ID#(1-5 digit number,found on tax statement): (8033 a 3, <br /> Proposed Use of Structure/Addition: tio MC -� <br /> Anticipated Start Date: ...Tidy Fri- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: OIC CO&J S71Z1(,CZ 04 Sewer Installer: //op 6116 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 11:7€ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 84j <br /> **The,tiplicani needs to contact their LII Inspector to determine if a permit is needed from them prior to W <br /> INY construction taking place far any dwellings, dwelling additions,manufactured homes,manufactured z <br /> home addif <br /> ns, and unkhouses.**6e( �RI Y"�f'a( <br /> L Q 7� <br /> I �� hc4- e?CC 3 foo S i� . <br /> ee 'I e.e ano '1'4- 43 exEeed 2(oC+,4 ilt1 <br /> Fee Rec:3OO <br /> / 4 Check#: 42-709 <br /> X117/ ?( L tri <br /> Date of staff site visit: Initi. s 1 site visits • • , r <br /> / / <br /> ' _,L <br /> I <br /> APPROVED BY LAND SERVICES OFFICIAL: % � / 1 DATE: � [ a' m <br /> 3 <br /> UPON APPROVAL: APPLICANT . UST POST COPY OF C 0 C 0 <br /> RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 0 <br /> cm <br /> cm 4 <br /> Transcendent: - Page 1 of 4 3 Z <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 ; d <br /> 6 <br />