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LAND USE PERMIT APPLICATION - Burnett County, WI a I r <br /> ' Applicant Complete All Sections Below This Line a 4 <br /> a i <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure _$300 Addition/Alteration to Dwelling/Principal Structure $200 `D' Ps <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 9 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ;', <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C') \ ► <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> 1;' Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 -- <br /> Filling/Grading , $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) ,$100 Permit Extension(1 Year Extension-Allowed Once) $100 L <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. R <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. r, lir <br /> r o z' <br /> r <br /> Property Owner's Name: IV ) <br /> \Cr C. ,4- •J to r \Ak. I +-1 I n C1 m ° ` <br /> Property Owner's Mailing Address: r,�c j t-� S tcd-c P o ac1 35 °- ,` <br /> 0 <br /> Lt�ebs-t� - 5 4g9� <br /> City State "Zipu, <br /> Property Site Address: Lk-) i 1�- icl I I 01 der iie�S t'V p. <br /> Par _d-1 A 1 z <br /> Contact's Telephone Number: ' '15 - ; (ctc., ea-4, • ; <br /> a ' <br /> Contact's Email: _ 1 C"'IC k,1 i U. I ICt t 1r i7f>J D Cl Co t ti 1 2 <br /> Legal Description of Property: I r l C 1 LA CI c CI j <br /> Section#: "7, X, Town#: t I-1O N Range#: j(p W Town of: on K 1 a h r( 5. 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): —1 r� <br /> 36z93 <br /> Proposed Use of Structure/Addition: ('_ct�n p L�N--o IA_ t1 Ct S{-ri J ('*0 re_ W - P <br /> Anticipated Start Date: 1 t"t•1 ill ecl(et fit-', (Home/Capin,,Commercial Business;Bedroom;Deck;etc.) h <br /> N0 <br /> Building Contractor: _ Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o'er ‘ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 6/fo� q// �n��otis � c�,p- z/-1o. z s <br /> NI <br /> 6 <br /> w <br /> o\ <br /> l <br /> x Fee Rec:/2 W 5 <br /> Check#: Mir <br /> LI 01 <br /> v <br /> Date of staff site vis' —' 7 d 609, n <br /> 0 Initials of site visit staff: Y � <br /> z <br /> x <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 0..eZV r 0 <br /> 2 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT n y CD <br /> r Cr c° N o <br /> 'Transcendent: - Page 1 of 4 ID N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 2 <br /> L JJ <br />