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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> C c <br /> b <br /> Applicant Complete All Sections Below This Line '`--O '' kte 9" <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> e <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure_ $300_ Addition/Alteration to Commercial/Industrial Structure $200 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> Filling/Grading $150 _Boathouse $500 o ti <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 m <br /> P <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. o . ' <br /> CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i-- g <br /> o <br /> / - <br /> Property Owner's Name: —rt. pm S CA n e C ti S�G Lenj J n z 1 p -, <br /> F. <br /> Property Owner's Mailing Address: X E.i rr ,C6) W t,,, - M 1) 5-cZ)q- $ <br /> J r- <br /> City State Zip <br /> Property Site Address: G)17 Phyti5 .,-iV ) meant- - L)...a'— c <br /> Contact's Telephone Number: (4/.S /- d C)6 - 3 Li-a o D <br /> Contact's Email: Li) d <br /> CD <br /> ro t <br /> Legal Description of Property: Sam x;24 l tL1 .3 KG j b St 161 VOLN <br /> % rro <br /> Section#: Z Town#: 39 N Range#: /G W Town of: /t4 e e r e-rte <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> n <br /> Tax ID#(1-5 digit number;found on tax statement): /.2c a.5- `� �c.,, <br /> Proposed Use of Structure/Addition: A r4 <br /> H <br /> Anticipated Start Date: Y (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) ° p <br /> Budding Contractor: ,rI Sewer Installer:—9 <br /> IP <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1 ie e c 0 SecHpackS z <br /> ey ( le CUP or 6 marC.►7Nj ?'?"''''' 'Cr'' <br /> CAenI - b g/i / -1 <br /> 035 „ n� A14,ert. .4 fig,hi ch' -z''1 y, Fee Rec:1/5/" <br /> 4 <br /> Check#: 56i&i <br /> d <br /> / m <br /> Date of staff site visit: / l IV-I Initials of s' visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: i_A,Ad, i/� 'r •TE: 71111/C72/ <br /> / <br /> UPON APPROVAL: APPLICAN `�� UST POST COPY OF g F 0 <br /> 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o = <br /> C 0 (4c <br /> Transcendent: - � <br /> Page 1 of 4 r....) <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 1 1511 <br /> L I <br />