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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) o ` k) '' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 • <br /> rD <br /> 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 I\I` • <br /> Ix Accessory 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 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100_ Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 5 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. e) <br /> ,*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c g_. — <br /> _''1��- cOLLJLI <br /> L_iVITT <br /> Property Owner'sName: -ET ��Q _ _ -.. - <br /> F hi <br /> Property erty Owner's Mailing Address: P Ul VL`��f <br /> .` JJ � n <br /> Property Site Address: `� �C'._. ` 1 � StateIA)/ <br /> ,Q <br /> ir-riu �U o i <br /> Cc- <br /> Contact's Telephone Number: 7 - is° A q 660__ a , <br /> I 1� r <br /> Contact's Email: (a 171 n ( � i ►' Al ` L c-,0 ryl <br /> Legal Description of Property: LOT <br /> Section#: 1 b Town#: l-I 0 N Range#: 15 W Town of: JK„,(jNj <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> r <br /> Tax ID#(1-5 digit number;found on tax statement): v, <br /> Proposed Use of Structure/Addition: t—}-r 7D / S"k, e � x <br /> Anticipated Start Date: '-_T ei IN.C7 Z('2 (1 /Cabin:Commercial Business:Bedroom:Deck:etc.) G <br /> Building Contractor: C{ , T (, C n 'S Sewer Installer: i --. t ••11 <br /> AREA BELOW THIS LINE FOR`LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 01 eek- aLI 5e+ 4Cts, s -[l.ne Wc-s 5�►Jeci • 4- 1-lo -� r i� <br /> a dto �G(�� -h� -I�c ewr-��5�fi ,�c Cs,�► No7- be. 'la.cl <br /> avtit Ya vvioecf awa ck i le+S <br /> ID NW-- k h1 ►.b,w)/) J i I� <br /> - Fee Rec:J <br /> Check#: <br /> z/ 1.-- <br /> 0 <br /> Date of staff site visit:/` -'4 1? / <br /> Initials f site vis�ste : ' L rn <br /> a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:3I/O/ ) <br /> UPON APPROVAL: APPLICA 7 MUST POST COPY OF t a 3 t tt <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ?g n <br /> 71 <br /> Transcendent: - Page 1 of 4 n -0 0 r,, <br /> Lasertische: - Burnett County,WI Lind Use Application—Rev 1/2019 'iZ <br /> EVm <br /> G r <br /> 1 <br />