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cn co <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a to <br /> Applicant Complete All Sections Below This Line <br /> a. <br /> e e! <br /> Permit Types and Fees:(Please,check appropriate boxes) v t`-' <br /> ,114Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ` �'"..— <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> AccessoryI:— <br /> Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o 1� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r-o <br /> .JJ <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-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. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o 5, <br /> n g z <br /> Property Owner's Name: �'t 4.1.-wy 1-- f e. / ,,i•c, cc 0 i S 0,-) 0 4. <br /> iid V roe 0 W �`n <br /> 0 <br /> Property Owner's Mailing Address: �' /'✓) <br /> p City Statg, Zip <br /> ' (� <br /> Property Site Address: // kei6 Y i c& c I-cede ,Z. trl).1 c 53 7 <br /> '' , <br /> Contact's Telephone Number: 76 3 Z 4/-f Y''/S 3- "7"-- g <br /> C <br /> Contact's Email: Of 6y 3 i ey,z. / Ca�t�t F <br /> Legal Description of Property: Y IU� 5L <br /> Section#:, O -/ Town#: 3 7 N Range#: / S W Town of: /..--., de 4 dt k- o crq U <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number;found on tax statement): P3251 cn <br /> .- v <br /> Proposed Use of Structure/Addition: "404,-`-, L ° Y <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' C7 <br /> Building Contractor: - Sewer Installer: C v"y ,rz.c. €S 0,-1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W U1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> ,..00 0 I <br /> Ow+ meek a(( se+hce XI <br /> CA. vtasnt s kcc(Q 4ime 04- i/15)& otmef ,'s , ,,ts.bGe <br /> 0 3 CLAiren litr e was pat ',/k:l4- -6 ti,40124 1b,Jai 1-di. 1, ,ee( 'b f t:5 <br /> a9 / .F m,{ be,- , used v►' �'r ' //,, <br /> 4 e 4 ( Cl v� e or 1+ can /t� Fee Rec: 1i 60 <br /> nG c'-tfidn ekt€4, 3 bCt/b0/n55 per 51,14/-a3-5.6 Check#: �1 C� <br /> �{ 6��e�i, �vf � P `� <br /> ate of staff-iite visit: I Initials site visit st R� r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: U/` 9/a,3 Fir <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF M9 co Z 0 <br /> -aim a o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CO c o <br /> �W-< IV <br /> Transcendent: - Page 1 of 4 �`., <br /> Effll <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <m <br /> h L� �J <br /> ct <br />