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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> g <br /> Applicant Complete All Sections Below This Line g' r it ids <br /> ww Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> x $150,-. .?.-Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $15 � I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ` (1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o S- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ii <br /> Filling/Grading $150 Boathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w +- <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. NNI p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. , g - <br /> n o <br /> Property Owner's Name:Ca a i C) E k4A2 (A 0 t EL,c 4..L; t L C fa „ V 1 z <br /> Property Owner's Mailing Address: / N <br /> p g pC�. �c1C 3RQ C�C��iPD I A SDZi <br /> City / State Zip z cn„ Cd <br /> Property Site Address: 299 Z� C� 1�. 'Lq L/� t�R�&t - - t sg83o --° <br /> Contact's Telephone Number: (Q 4 ( -- -7 S I - `l'cl5 a <br /> Contact's Email: .. C� .e �to t-v CXCd 4 e.C- " �.- �� —' <br /> Leal Description of PropeBrty: /, .-i1 <br /> g P P ItY G--1 �j LI`�T ,4ti to i>,iT�PXS+'1 a l (,��T(>;T o Z (b <br /> o <br /> Section#: 3S Town#: A \ N Rail:,„-#: /6) W Town of: S >�1,SRail:,„-Rail:,„- <br /> q <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): GE _5;S -7 - <br /> Proposed Use of Structure/Addition: MASt3L_ C .V2Ce-A--1 SrpiN4.LSio / NICZ ' T L - - ) 1W, o <br /> Anticipated Start Date: '5EPT C�PjLT (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1A'tA V, e <br /> Building Contractor: c i_VAN . Sewer Installer: �Q�(� - i(' L�; ,r)_yy�j( '� <br /> 1-iovc..2Mp�J IdSi .vL- teki i iMC-, .-t ,- N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -- <br /> THI PERMIT IS SUB CT TO ALL CONDITIONS LISTED BELOW: <br /> 0 ✓ranee ll se--b.‘ • z �l <br /> 9/�ve (�o 2x�eec, a be(jf S 4I b ee.,rbo.�J , 4m <br /> 1 <br /> >.4 use per v pp-)s- a7. <br /> C, Qce_e i5 R t M ec 'o&c5l~r4ce pNlc- be'/ /n,'5afi� S cgrt..,� K �4 ✓l. FeeRec• 50/leeA1 a lied IAl pe J+v.g5 ` vJ Check#: 1 ti O I <br /> / U 8 <br /> Date of staff site visit:�j/(Ql2-3 Initials site visit ff: r 1 e r <br /> • J / 6. 1 .___,&____,t3 t <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:B( �( ?3 m r <br /> Ngi <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF > x <br /> sr)ED 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o ' <br /> Transcendent: - o <br /> Page l of 4 g Z to <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 < 3 ca...) <br /> CDinni <br /> i <br />