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LAND USE PERMIT APPLICATION — Burnett County, WI g b <br /> Applicant Complete All Sections Below This Line 5 N <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) e. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " CJ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Va 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> Filling/Grading $150 Boathouse $500 ° <br /> ilk <br /> Six Month Camping Unit(One Per Year) (1Once) $100 d <br /> p' g $100 Permit Extension Year Extension Allowed <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ES <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. o <br /> N\ <br /> f r <br /> Property Owner's Name: IC i'1 0e,I * J-e(_n \/V a I +Z 1n <br /> r <br /> ' ,1 0 <br /> Property Owner's Mailing Address: c '7(- 5 J to.±e. Plc ad 35 �)e bs-tc✓ VI_ `J 4093-g <br /> '' ` � . A\ City'/� State P� 0 <br /> Property Site Address: W h I to t I Lt)1 id e tr. (1 CSS 1``U Par Kj 1,�p't"`1. 4ov / i <br /> Contact's Telephone Number: `7 15 - '(c�(o - s a r7� \ \� o <br /> a � � <br /> Contact's Email: ugh I e.fiC�I 1 I IC'I e l� 17eSS h Mai I . CO m —0 0 <br /> Legal Description of Property: 1 II C 1 U d r CI N <br /> so <br /> 0 <br /> Section#: c Town#: t yO N Range#: f(p W Town of: Ors K Ian o <br /> 0 <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 6 2-9 3 <br /> Proposed Use of Structure/Addition: C.0. �}� co LL Pl C� sly I,) r�--0 ire W o x <br /> F <br /> Anticipated Start Date: 1,(1)(71eai Ct t'e, Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^1 �1 ° p <br /> Building Contractor: /\//A Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> GGTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 rc/%& G// 6.2/4 4%t ' Ei9 CUP-al /Do z �O <br /> W <br /> 6N <br /> H Fee Rec: /Z/517° <br /> Check#: g/9g <br /> o <br /> Date of staff site visit 1 i 7"‘9 0 Ini 'als of site visit staff: 'tk' V\'� r <br /> y , <br /> 7 C ' <br /> APPROVED BY LAND SERVICES OFFICIAL: - DATE: 3/Z/ a rm <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF k k°c. <br /> <. -< CS7? <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT •a �: <br /> / 1::: <br /> Transcendent: <br /> Page 1 of 4 3 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 Nnl <br /> (oJ <br /> Y <br />