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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 5 <br /> aT, <br /> C7c7. F 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '0Q <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> V <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G <br /> ��JJJ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' o (t) p <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 1 �- --• *II <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ; v . <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. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. , r 9 <br /> o Z q <br /> Property Owner's Name: © �'---. 0.112,-(S h ° �• <br /> Property Owner's Mailing Address: 0 •-8tau aq 9 S1 PCS w 4 `J,4E7 2 �_ <br /> ' / City State Zip n <br /> Property Site Address: c2`t S.095 Ji ) b2_ _ c' <br /> Contact's Telephone Number: (, — ( —LC1/8 <br /> [ .2E7a <br /> e <br /> Contact's Email: / r) <br /> Legal Description of Property: D e�at-kr C. res �" CJ <br /> tic <br /> Section#: 11 Town#:__3 8 N Range#: I 5 W Town of: la- Fa (` ,t"' <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): ( 0 o9, <br /> Proposed Use of Structure/Addition: Adc:11-4-'i of, +D 4 �Ii- o <br /> Anticipated Start Date: 57. 1/9' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> PA'Building Contractor: Sewer Installer: CA•a '� <br /> O• <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/ NDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 1/1'(ee4' ql �b <br /> SP. . 5 z ..--k34:!.--- <br /> It <br /> Fee Rec: <br /> Check#: Ch <br /> Date of staff site visit: 7P-1 /?-.1I of ite visit staff I <br /> ce <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: B/01/01I <br /> < co <br /> UPON APPROVAL: APPLICANT %BUST POST COPY OF U tl+ <br /> R.g N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -- o o w <br /> Transcendent: Pae 1 of 4 x `` as (%o <br /> Page a <br /> Laserfische: Burnett County, WI Land Use Application-Rev 1/2019 <br /> y L ' ..J <br /> T <br />