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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> • Applicant Complete All Sections Below This Line S. <br /> ot4 V% <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> o <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 , r•••••• <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 t; <br /> Stairs/Patio/Retaining Wall/Sidewalk _Bunkhouse $250 <br /> A 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 <br /> *NOTE:After-the-factpermits q begun)mayup i .6 <br /> (permit aqui after construction has cost to three times the normal fee. � � <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ,Z <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> //ii _ lip3 <br /> Property Owner's Name: (�R FA gAJ o <br /> Property Owner's Mailing Address: 14 b 9 C C_ 5106404 UIj 55830 i <br /> n J/ City State Zip <br /> Property Site Address: 174h/f (�./...y. pd e. <br /> K <br /> Contact's Telephone Number: 75S•, qi9- Rah o i <br /> CD <br /> Contact's Email: , iv c a c3 e i ,,I , £ :ill .J d <br /> co <br /> Legal Description of Property: Slc)ft Ng Y S 1 ir, T /UR/'..-- .. <br /> �,T1N vo <br /> rf <br /> Section#: /& Town#: N Range#: /5-' W Town of: SAC,e5GA/ <br /> E. <br /> *Attach additional page i needed or lengthy description OR attach a copyofthe deed OR attach taxsystem property page.** °0 <br /> P g .f f 8 Y P P P tYPS d <br /> Tax ID#(1-5 digit number;found on tax statement): 5-PS/3 <br /> Proposed Use of Structure/Addition: A,E. K �„ <br /> Anticipated Start Date: L',2. '-p7fi'd,� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 55 0 F, <br /> E <br /> Building Contractor: S.'EL E Sewer Installer: 4-2k/.$01) VAI\I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITION ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z 9 <br /> po <br /> fYflee4 <br /> alt 5eCitel,"5 <br /> Fee Rec:/'` ��� <br /> 8 Check#: lP <br /> 64?R I?? tt <br /> Date of staff site visit: In'tials o site visit : CVLA <br /> APPROVED BY LAND SERVICES OFFICIAL: ` DATE: 6/36/2d, . o <br /> .r <br /> UPON APPROVAL: APPLICANT , UST POST COPY OF , <br /> z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N ". <br /> 00 <br /> Transcendent: - Page 1 of 4 m = a u' <br /> <' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 S,- N <br /> r.) �' ' <br />