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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line B <br /> ,, <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> ro <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 ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n lb <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° r . <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> 0 <br /> Filling/Grading $150 Boathouse $500 II <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 (/' 14 <br /> z <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. -o <br /> rD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t-- r� <br /> 9. <br /> Property Owner's Name: M I c h 0 e.1l `+" i tan \/V C I + i l l I -n z • <br /> °o � <br /> 11, <br /> Property Owner's Mailing Address: c)'7 45 J to -Dad 35 We bs-icr VI- 5 L f 3-6 <br /> City - . n„ <br /> Property Site Address: W, 11 I fiQ t I I � Ir 1 e I eSS U Pox L_A _i <br /> C <br /> Contact's Telephone Number: 15 (,--lc, a r-i cc, o a. T <br /> ' Nod <br /> Contact's Email: WV-)I -1"e.ta t / t )I let r i()r55i 11cfi m CU I . CO►'n <br /> ` <br /> Legal Description of Property: I rl C I Lt CI r CI o w I <br /> Section#: :3 Town#: 1 1.40 N Range#: ((p W Town of: OuK)a n C/ uo <br /> nl <br /> d N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> QN <br /> Tax ID#(1-5 digit number; found on tax statement): 36 29'3 <br /> 1� c o w <br /> Proposed Use of Structure/Addition: LP-a)p\R Y"0 IA nd SfrL.a (`*Ore_ W . <br /> Anticipated Start Date: ►�(t")fl'leLtt ct-ie Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N ^ , ° p <br /> Building Contractor: /\//A Sewer Installer: ` -3 _� ` .1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: a N/olloCO q// coLtcZ>ONs ►M cUP-ai-IO. z s ( <br /> x W <br /> N <br /> H Fee Rec: i 2)5W <br /> N Check#: R./9 <br /> lC <br /> Date of staff site visit: C.7,— , ` +��Dr t_ Initials of site visit staff: /� M i'' <br /> ,. <br /> n <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3�Z�Zo Z. X <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF © <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i§o N <br /> 0 <br /> Transcendent: - Page 1 of 4 t1 c <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 ill <br /> L� iJ <br /> 6 <br /> ro <br />