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r. <br /> • . LAND USE PERMIT APPLICATION-Burnett County, WI k C <br /> Applicant Complete All Sections Below This Line o c 10 . <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) d U <br /> 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> :: km <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 th'N 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 ? O <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(1Year Extension-Allowed Once) $100 ,� <br /> " \ o <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S i t <br /> � o, <br /> Property Owner's Name: „ /y .. 4'n� (49tai oAl <br /> O <br /> Property Owner's Mailing Address: /26 . rfeLOl,,fir R(6t) !�,/ /�� S./1� b ' C <br /> i S to Zip e' % <br /> Property Site Address: 3 J 74 5a y,i N/c� . go M> War gatt'R W r 01/ 3 E <br /> Contact's Telephone Number: ifs gbV' ' $ : L <br /> d <br /> Contact's Email: . ( e• W• CjG*y i t9Ii (�r C,,,�/fwGV/1 Cd/nro <br /> Legal Description�off Property: 6ct.iietii if/6tGrvr. (b or Jr i u. <br /> , <br /> Section#: 35' Town#: 40 N Range#: /5 W Town of: .J4CKSC1!) "�° <br /> P. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> ^� n <br /> Tax ID#(1-5 digit number;found on tax statement): ( v45 cA <br /> Proposed Use of Structure/Addition: Aster/ (.fi'g/1J W <br /> Anticipated Start Date: F74�L.Zt4Z'f/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 C7 <br /> /p , o I t ( .� <br /> Building Contractor: >I IAA? Sewer Installer: 4 V.t^11n • Q <br /> AREA BELOW THIS LINE/FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 O <br /> THIS PERMIT IS SUBJECT TO AL11 CONDITIONS LISTED BELOW: (� <br /> in Ow ill►`►k vio f ¢v eXr e t- t ' beoMs er . /f N- 2 9/--t' : z o <br /> 0 Du) e.111� l5 a ice_ <br /> S�at� a 7 ,✓' AI * <br /> e✓*i a t,1'G DPI c_5 to ,e- 7'0 tM P e_ - 41/ 07L4 e . 5 a s <br /> 60A4zte IApL art5ptche 7127 o 1 7lati'vt Yit.ea'(/' Pe-i^w` i17 <br /> 0 <br /> Fee Rec:300.v'.-- <br /> Check#: 11 0.S 3 <br /> 2tz <br /> Date of staff site visit: I Z/? zo ZJ Ini 'also ite visits )2'7 tz <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 5 01)Z7 V3 a Ififfl <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF ??g ' 'fi'nnn'' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 3 W <br /> Transcendent: - Page 1 of 4 P a <br /> BTfl <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 LL JJ <br /> a <br />