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LAND USE PERMIT APPLICATION — Burnett County, WI a 'IV r <br /> b <br /> Applicant Complete All Sections Below This Line 0 �f-• <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) F o 00 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \0 <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 /> n C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> / Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r, 15, . <br /> ' Filling/Grading $150 Boathouse $500 P <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> t6 <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 /> ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> Property Owner's Name: t A 1 c I'l 0 t I -I-- J ta_n Akt 14 Z i n G '1-1 ` o <br /> -� Eo <br /> T1 <br /> Property Owner's Mailing Address: c)`7 c ,3 J tc ±� ( 10 ad 355 W b5-Ic✓ W Z 5 4I91 j� <br /> ,, ,, w n <br /> Property Site Address: W\\l' I t a l l 1 t�E Ir n ess RU Par% t_I h. <br /> Contact's Telephone Number: (7 15 -p(,,tc, .- 6 3 e7c, o $ <br /> ` • <br /> Contact's Email: L_Ch I t e 1 Cl i I LU I Id f ir 17e55 r hD Cll CO in ---- -0 n <br /> ilik <br /> Legal Description of Property: 1 rl C\Lt C\e CI o 00 <br /> Section#: :27 X Town#: 1-10 N Range#: f(p W Town of: nrLK 1 a n d o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* R <br /> F <br /> Tax ID#(1-5 digit number; found on tax statement): 3 6 2_9 3 <br /> p <br /> Proposed Use of Structure/Addition: C.-C�-rn��Y-C IA t1")d Si-r(..1 (\�" ()ire_ ‘ uJ � ;,w <br /> Anticipated Start Date: If1)inejtt GL1'f; Hame/Capin;Commercial Business;Bedroom;Deck;etc.) V <br /> pBuilding Contractor: Ai/A Sewer Installer: J <br /> A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 't <br /> 0 iq,//ow 4// Con .:: ba S -erviA . C U/1°-Z!-/O. z �O <br /> H Fee Rec: 12i 5120 <br /> y Check#: m e <br /> ��y <br /> O <br /> Date of staff site visit �/�� CD Initials of site vis' f: )1--- y <br /> O r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/Z7,ZDZ go �(1( <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF r 1 .t © <br /> -, (D M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o NJ o <br /> / 1:: <br /> Transcendent: - x cp <br /> Page 1 of 4 M <br /> n <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 a <br /> ur <br /> Y <br /> 6 <br /> '0 <br />