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LAND USE PERMIT APPLICATION—Burnett County, WI g <br /> Applicant Complete All Sections Below This Line CI'i. CD o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 G <br /> Commercial/Industrial Structure $300 X Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � EO Accessory Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0_ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 c 1) <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. �. CI' <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 <br /> AI <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 <br /> s P. <br /> Property Owner's Name: t j i j -Pa 1j14 ht e <br /> Property Owner's Mailing Address: 7/-41(10 p u 01/el �h7ha, (' (,(,y c)y�d <br /> City / State Zip v11 <br /> Property Site Address: 7 t 2G /Ca Lc l,)4/1 - �a ij c.(, y Lt./ i/ ?O a <br /> 3 <br /> Contact's Telephone Number: r52-// --fas "'—i5 s/(e2/6- 3.3-ci/es") o c <br /> Contact's Email: Palo <br /> u M NCc,0 i 60X/1/od. Cijfrnit <br /> p <br /> Legal Description of Property:/2/U,) kV, 5"C_�j fp t...47�-1/j) V/A/bett,,✓Q /1(.t, <br /> Section#: 22k Town#: Y/ N Range#: / W Town of:LSwt S SiVi -0 <br /> ei <br /> 'Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* p <br /> H <br /> Tax ID#(1-5 digit number:found on tax statement): 5_ <br /> Proposed Use of Structure/Addition. (1,Aity/rvl' G.l ?u 5,i1 S to <br /> / o <br /> Anticipated Start Date: ` 7 5" (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) F '- <br /> �'/ o El- <br /> Building <br /> Building Contractor: �;Lr �,,�d� h Sewer Installer: <'L <br /> t4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY PJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> '1h( ; <; ..,vl from them prior to VI D <br /> I\'} cottstrue1un,taking place for any dwellings,dwelling additions,manufactured homes,remanufactured z U, <br /> home additions,and hunkltouses.** z <br /> tta <br /> z Fee Rec: <br /> !t <br /> /h / Iv Check#: 44)24� <br /> Date of staff site visit: ' .-42145 -6)16 c Initials of site visit staff: ` i <br /> APPROVED BY LAND SERVICES OFFICIAL: I r ATE: /0-a°-34:'g''' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a ,_. Iffi <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Rz <br /> = gill <br /> Transcendent: - Page 1 of 4 is <br /> 2 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 6/2020 Z la Q <br /> mCD <br /> OW <br />