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.11 <br /> LAND USE PERMIT APPLICATION—Burnett County, WI a• b <br /> Applicant Complete All Sections Below This Line o c <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "�k"--.1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 • C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 5 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e Lir L s <br /> Filling/Grading $150 Boathouse $500 t- Lt <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. o � <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. _ p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -J <br /> r. <br /> •Property Owner's Name: `V n IQ:1'k kA VPb{C-Z ISS IT 1-1.4.-- D gM LAy 4:41 ) S i <br /> P <br /> 1.41 <br /> Property Owner's Mailing Address: P D &xIPPSI Du q V I 61143 <br /> o ' <br /> Li <br /> Property Site Address: b 2 g I �Ua j�I y /kD �I ty o State Zip E. <br /> r <br /> En ik <br /> 6 � �t �� e rContact's Telephone Number: 179 o <br /> E „.. <br /> Contact's Email: nr)Aloti t rJnefl-1 UWP 20 7 116..5. eom ...... <br /> _ a <br /> i ,4-01.)95 � R.Le al Description of Property: L ' I im V• 12 P . An, o 1a-0;'fie a = zi-a SGtW IJ%i <br /> P <br /> N voe <br /> Section#: p�I Town#: N Range#: 15 W Town of: iI � S <br /> 5' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ti <br /> Tax ID#(1-5 digit number;found on tax statement): 5 1+4-2g• <br /> Proposed Use of Sttuctureddition: cfl <br /> Anticipated Start Date: t✓i "(1' (Hoare/Cabin;Commercial Business:Bedroom:Deck:etc.) k <br /> r Building Contractor: Sewer Installer: UJ <br /> e <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ". <br /> **Th, tips tci.dfi.?i. ..sc'tt,.t9 tittz tiv.f f/da:'t}'tiDCIti„Sf ecio) (0 diCii`f'iidtitt'ij a pC':,';t is ner'UCtl jf'ont them prior to <br /> .4NY construction taking place for any dwenin,s,dwelling additions,manufactured hones,manufactured 'z' • QIZS <br /> home addi • s,and bunkhouses. k <br /> i i (its <br /> It <br /> filhe + Se g. <br /> 140,- 4f Kiiin 110. 1) -14)%6 #/i <br /> Fcc Rcc: it0(542 <br /> L Check#: 5 2r <br /> 71??!?-( �- M <br /> Date of staff site visit: Initials of site visit staff• ,_ <br /> APPROVED BY LAND SERVICES OFFICIAL: 4V �j DATE: //? ?/ <br /> / % ls�ni <br /> n uau <br /> UPON APPROVAL: APPLICAA''� MUST POST COPY OF 4 u 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z y ilifi <br /> 0 <br /> K A C PFJ <br /> Transcendent: - Page 1 of 4 �° `7) Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020. a, IM <br /> L---- ) <br /> m <br />