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LAND USE PERMIT APPLICATION - Burnett County, WI 5 r <br /> Applicant Complete All Sections Below This Line 0 -- --. <br /> FD* SOP <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Y p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 W <br /> o <br /> / Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> UPI q <br /> / Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -moo <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-. <br /> f ° c <br /> Property Owner's Name: M t C Y 10 e i "4-- •J t'_ct t- \VQ I Z l h 71 o <br /> sit <br /> ' 1 l o —_ <br /> Property Owner's Mailing Address: c `i(l a5 J fiat E f 10 a Wd 35 .bs e- VI_ 5 4B9)-6°' <br /> \ City tate p (4 N. <br /> W Property Site Address: hi f e.to II L&1 Id e Ir n e5S t2U Par K -1--it. 4 <br /> o N <br /> Contact's Telephone Number: 171 5 -g( , - e a r7so a p <br /> Contact's Email: L)h► t etCl1 J W 1 LC`t ( r e55 @ 00- f1'1Cu I . co r1'1 <br /> Legal Description of Property: I r-1 C 1l t C`t'CI N <br /> 0 qv <br /> Section#: :2)c-A Town#: 1 40 N Range#: J(o W Town of: oQ K I a ngo <br /> u. <br /> *Attach additional page if needed Ibr lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): -I 38'95 36 3 6N <br /> Proposed Use of Structure/Addition: o <br /> C.C�rn P R(Q Lt. nd Sty- (` f l)✓e_ x <br /> Anticipated Start Date: lr t r1"1ea1 cut-e', Home/Capin;Commercial Business;Bedroom;Deck;etc.) , N ° p <br /> Building Contractor: A//A. Sewer Installer: .- O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY D <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (U Fo//D to c // co tl ch'i rrr15 gt9ptA CO f- 2-/O. x <br /> . Fee Rec: I2$nv <br /> '^^'ll tr�,�J�\ Check#: si 9 <br /> r t�� ' `� C <br /> Date of staff site visit: / 7-cb Initials of site visit staff: r <br /> —�OJ <br /> APPROVED BY LAND SERVICES OFFICIAL: ::::1-)/9*-44----- DATE: /z- ZO zV <br /> gird <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF I <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Transcendent: - Page 1 of 4 -'` I <br /> .:: <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> n L-. J <br /> fi <br /> b <br />