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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> .1 b <br /> 4. <br /> Applicant Complete All Sections Below This Line o e - <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> CD <br /> ' <br /> p- ---, 0) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `, <br /> r <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,,.._. R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 � Q <br /> Filling/Grading $150 Boathouse $500 tr <br /> in Unit(One Per Year ° V <br /> Six Month Camping g ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red 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. .�\ <br /> UIkemu <br /> Property Owner's Name: N/0kft-4 MP I:WPC- it sJ LL Dg/k LAI' 'Ak) o z ►�. <br /> Property Owner's Mailing Address: P D• 1�DX. PA-f g(,fi{n.�.( VI 6L4430 o ,'t <br /> ra A ��� � city State Zip $ It <br /> Property Site Address: ���, ( Illi A�,y 1 1►1�� 1� "L~✓v i i t,.i� �� <br /> Contact's Telephone Number: �,�r = o i <br /> Contact's Email: M t (JOitl lt7-1 O/ ot't.r<-1 Stij' . e'oAA <br /> d <br /> .lt'219 r —°t�}a et�Ie al Description of Property:y: IA- i e. m q. la P .. an, 0E- moo: he t.6 � ,. 4 of- e a:.'/ <br /> N b <br /> Section#: a I Town#: N Range#: 15j W Town of: jlk )/` as d' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach lax system property page.* d , <br /> Tax ID#(1-5 digit number;found on tax statement): ;J r <br /> Proposed Use of Structure/Addition: CI 5 -----pri - sUin.qv2 <br /> Anticipated Start Date: (Nome/Cabin;Commercial Business:Bedroom:Deck:etc.) !Ij• ii ii <br /> Building Contractor: Sewer Installer: ^ - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY H _.l , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p <br /> **The tali a?d'ir't. .a,..w,.1,,.wit,l ,?i,,Ir L Lk.. d} il)e'ciaiit)tic'ft'i111Wt'id,i pel-mifi is net ilea jrot)i them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured 'z home additions,and bunkhouses.** ;rr 9 <br /> f n.eeA- qlt 5eA-b ,'oil <br /> 5�ee Oa* c( k,,,,rn4 ii l'14 b,a4 <br /> Fcc Rcc: i,2.5t2 <br /> //7/ Check#: f '7 O <br /> Date of staff site visit: 6 /I Initials site visit staff: v <br /> i <br /> APPROVED BY LAND SERVICES OFFICIAL: 7DATE'//(?l i �� <br /> n <br /> UPON APPROVAL: APPLICAN / UST POST COPY OF y <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT q ;•3 <br /> '4 y n c..71Y Fro <br /> Transcendent: - Page 1 of 4 o 2 N., <br /> Laserfisehe: - Burnett County,WI Land Use Application—Rev 1.2/2020 03 Q <br /> -i Erifg <br /> I1 <br /> g I <br />