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o <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> i7: 75 Applicant Complete All Sections Below This Line s rro v <br /> Permit Types and Fees:(Please,check appropriate boxes) y - <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 CA <br /> Permit Extension(1 Year Extension-Allowed Once) $100 S <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. g. 2. h- <br /> *ltems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> >r cin Lt �tscu-� G c <br /> Property Owner's Name: i (t*1 <br /> Property Owner's Mailing Address: 0444 I - til A) Call l i s MN) ��� 7 4� <br /> City , State Zip `,2 <br /> Property Site Address: 2'90 �'�, I..! C-.1'i ,*& A't '*_ _-) <br /> I <br /> �63'31'J-1-1 <br /> Contact's Telephone Number: � ° , <br /> Contact's Email: VIOt(teltceal t tc--jl"nG1.t-k'(--zo'1 N -o w <br /> c 'C <br /> Legal Description of Property: �►� ''�-EA l©� i d <br /> 17 NJ <br /> Section#: 1 3 Town#: ( N N Range#: t W Town of:-3—O -S (\ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> tn <br /> Tax ID#(1-5 digit number; found on tax statement): (Q 19 o ti <br /> 3 £ x <br /> Proposed Use of Structure/Additio is 0.0.2(Irl C4 0._Ct. eQ rc c <br /> Anticipated Start Date: Si / . (Home/C(14 n;Commercial Business;Bedroom;Deck;etc.) -i <br /> Building Contractor: 3Wil ki Sewer Installer: v` . \ Qv" <br /> iebF_b ' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: p V <br /> o eery- all am s I fr aOwe ilt na- -la exceed ). '°415 pei 5/11v-?a- <br /> _ Fee Rec: <br /> c Check#: l Ceoo <br /> o <br /> Date of staff site visit: ‘ i.)10/11e9- _ Initials .f site visit to n <br /> / 7 Q <br /> 1CA <br /> 1 <br /> APPROVED BY LAND SERVICES OFFICIAL: /.. DATE:�!J 1.2.- - m n- <br /> UPON APPROVAL: APPLICA UST POST COPY OF '''' IT 0 <br /> a) � llifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o oto <br /> . 0.Z n.,Page l of 5 m 3 N <br /> llii <br /> Burnett County, WI Land Use Application—Rev 12/2021 < a <br /> rnn <br /> 3 <br /> b <br />