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LAND USE PERMIT APPLICATION —Burnett County, WI 5 <br /> Applicant Complete All Sections Below This Line ai le.., ' <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 L.'.' 4 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 9 <br /> XAccessory 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 ! 9 <br /> L� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t— <br /> Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 c <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. P <br /> p.. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ry <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o g <br /> s z O <br /> Property Owner's Name: U�b U�-�.— r <br /> Property Owner's Mailing Address: oZ`'`et D Co r.-uA- C.-vC'C-- J r o 5;r ,'t co/ sift?).o ``` <br /> City State Zip E. r <br /> Property Site Address CtS(D L., _(CyJC Li,J ('e_ c"1"e.'‘. LA.) 1 S1-1 7 <br /> o ' <br /> Contact's Telephone Number: 0(Z-� (p'Z— o' _C' '� a <br /> Contact's Email: �<�p\—a C� \9a(a @- 6--- _,..1 . 1 <br /> Legal Description of Property: Cil 04 rl d.. s ci-- kSc r scar s PIA <br /> A" <br /> �1�' 1-1) 9 <br /> Section#: N3Li Town#: _31 N Range#: / GI W Town of: i v l 2 c t Ct N E- <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#(I-5 digit number;found on tax statement): 1 a 14 ls <br /> Proposed Use of Structure/Addition: .� ra, . x <br /> Anticipated Start Date: ome./Cabin:Commercial Business:Bedroom:Deck:etc.) ° -e <br /> - <br /> -- <br /> Building Contractor: Sewer Installer: 4� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ( C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: L <br /> • (1eek a.t( �7 b&ck z <br /> ic* 4ihµ/nct1 Ikabt -h P0 1 j,lef a ;.:::A0 (.5 aeAr (iftGL'ic b )(- '''''1''J v7? , 1 <br /> -I Fee Rec: <br /> Check#: /00.3 <br /> Ei <br /> Date of staff site visit: 9 I I II id—( Initials o site visit staf r <br /> �� / ) .1 <br /> APPROVED BY LAND SERVICES OFFICIAL: f&4, 4(1/40:0! ,{DATE: /�/ ,'r <br /> nt <br /> UPON APPROVAL: APPLICA T MUST POST COPY OF Q co v <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - o o c <br /> CDC N <br /> Transcendent: Page 1 of 4K <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019151 <br />