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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> i' s N <br /> A .I licant Com.lete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 :,i) ^ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> f <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 I O \ i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 << rvC' <br /> Filling/Grading $150 Boathouse $500 o l3 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 I^ <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. -v <br /> T,^�++ � �rr� � c ., <br /> l\ <br /> Property Owner's Name: Il l`e \\-,111A-NUI .UI - z <br /> Property Owner's Mailing Address:a 1A N, P rr1-Lai& Rd \NCES4rWt Jc.�6"1.3 oF. <br /> * <br /> - City State Zip -, <br /> Property Site Address: Lj(j,('t1 r9 <br /> I <br /> Contact's Telephone Number: D1- a i.- 01 C1 ( o- s <br /> a. <br /> Contact's Email: by m►�hvin� t�4.lf10+Com a <br /> av <br /> Legal Description of Property: <br /> -o <br /> Section#: Town#: N Range#: W Town of:-3-0.,a_114±1--\ _. °' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> Tax ID#(1-5 digit number;found on tax statement): i <br /> Proposed Use o Stru ture/Addition:,� `� .!*'1 :it):t',0`ts'- —lC r e\K� _ r" <br /> Anticipated St.•. `.pi'1. Q ) I( ala i (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) K <br /> I = o <br /> Building Contractor: i' 1 6 fed- �e.S.}t X(0 Sewer Installer: �' <br /> �i�A dims • <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF'COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: n <br /> 'The applea'ua;a iie 1.3.o carr taict to«ci l i.iL tat',pcttrtt dc:cieh.tr,,ir;c ;i (4 ilOrriat IS.114.Vac:.,jarr <br /> ' .ai thetet 1.13' V <br /> .INF construction ialw', )l(1( fm any dwellings,dwelling additions.manufactured honk's,matualarii : z 0 <br /> .laosaae^addition.,, and hiirakl.ui..,'t',.*''' a <br /> ($ 1(r1 e ect1t Sekcjts , <br /> uu,)A- �( h,/0441 ��b4Alo" <br /> Fee Rec: [5 - <br /> CI / N Check#:av33 <br /> rn <br /> Date of staff site visit: `i6C f In' 'als , ,site ' 'staff: t%_� <br /> D. <br /> �j D. <br /> n b ___1;JD <br /> APPROVED BY LAND SERVICES OFFICIAL: W�.� , /i/i���� DATE: Of(7 ^ <br /> ., // UuU <br /> UPON APPROVAL: APPLIC A ►- OST POST COPY OF >g g 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> t., Q <br /> Transcendent: - Page 1 of 4 0 <br /> a <br /> NJ <br /> Burnett County,WI Land Use Application—Rev 12/2020 3 <br /> Laserfische: - 1 <br />