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^a <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a n <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/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 n <br /> AccessoryStructure Commercial Industrial(Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse $150 <br /> f Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o <br /> / Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C, <br /> Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 iv <br /> _. <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. -c <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 .. <br /> I, z C_ <br /> Property Owner's Name: M ICY 1 C1 t I `'1" -J ta Yl \_Afa. I +Z l {r1 ci „ ° CI <br /> Ei <br /> Property Owner's Mailing Address: a r7 tat e, t2load 35 Websic,r VI__ 540g3a <br /> 1 ' City z <br /> Property Site Address: LO h 1�- fia I I Lk)1 id e Y- n eii 142 V Pa r K <br /> Contact's Telephone Number: `7 15 -R(c-(c> - 8 c 7 ' N _a '_ <br /> o <br /> Contact's Email: Lo 11 t eta 1 / I l Cl t yr ne.55 V10fi ()ICU t 1 . CO nTh ....:11. 0 <br /> Legal Description of Property: 1 r l C,l t Cl t--a o 00 <br /> _ N <br /> 0o <br /> Section#: �j Town#: 1 �C N Range#: f t,0 W Town of: OaK_1(�n Cf N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 3 Co Z9.3 <br /> -� <br /> Proposed Use of Structure/Addition: C(MT).p R ro IAn d S{_r L 1 (`I-ore_ W ° x <br /> F <br /> Anticipated Start Date: 1)I`rledi a-t-e, Home/Cahin;Commercial Business;Bedroom;Deck;etc.) ^` ° 5Building Contractor: iv',/,A Sewer Installer: — 1�► <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a` ^, <br /> 0roi/O/,0 q// �xW�DMS w. C U P-al-/do z ' 1 �' <br /> G <br /> Fee Rec:/2, 0 <br /> Check#: gl9S" <br /> Date of staff site visit:) ' O Initials of site visit staff: \J <br /> m <br /> :1=2,JC:3 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/Z/-1° a V <br /> 151 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF ' CD c f 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w 0 N50 <br /> Transcendent: - Page 1 of 4 g� <br /> I C <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 Hi <br /> ..,, (!....... ...Li <br /> 4 <br />