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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> P <br /> _ r <br /> Applicant Complete All Sections Below This Line o ti <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) 0 p(� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial $200 0\p` O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 ,(N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 , b <br /> Six Month Camping Unit(One Per Year) `p g $100 Permit Extension(1 Year Extension Allowed Once) $100 m <br /> 0 <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. co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r., <br /> o ` <br /> Property Owner's Name: v l IC i1 Q e.I `'+' -J ea t1 \/V(1 I +Z i Y1 o <br /> Property Owner's Mailing Address: r/(i S toi e_ Plc ad 35 We bsi r VI_ `J 409)- li <br /> ` City <br /> W Property Site Address: I I to t i 61 d e r n ems R.Lt Par t t 5 '' <br /> Contact's Telephone Number: `7 i 5 -'(c)(.0 .- 8 a`-4v <br /> a . <br /> d <br /> Contact's Email: WV-)1 t e tck.i i U)I ICE t.1r nes5 hC 1 (Y1 Cu I . CO in ' . — g. <br /> Legal Description of Property: 1 r-1 C\Lt CI 'CAI oon <br /> 0 <br /> Section#: :27 c-A Town#: 1 1-4(2) N Range#: I(p W Town of: �(�,CK I a n d o <br /> — ., <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): ,38q - 36z93 <br /> Proposed Use of Structure/Addition: C.0.rn p V U Ll nd fp-t"Y I (`+ore_ x <br /> Anticipated Start Date: 11l al ed i Ci 1---e, Home/Cabin;Commercial Business;Bedroom;Deck;etc.) h <br /> p <br /> Building Contractor: /\j/A Sewer Installer: -3 `. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .n <br /> �'TH�IS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: A N <br /> L% / ��1i7/t) 0,ce/4 i` 01.1 &IM CL!/-' <br /> D Zl-/Qe W <br /> Fee Rec:/Z2 37 O <br /> Check#: 5798- <br /> rr r Q <br /> Date of staff site v l�"�c�E Initials of site visit staff: - I �i�' y r— _ <br /> C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Y0-0 a m w <br /> a <br /> Fi UPON APPROVAL: APPLICANT MUST POST COPY OF 1 W w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Co.11 2 N <br /> Transcendent: - Page 1 of 4 3 <br /> rr, CD <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 t <br /> C .______A <br /> v <br /> -1 <br /> 't7 <br />