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• a` LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> D <br /> Applicant Complete All Sections Below This Line <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) c1 -0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '` - <br /> Commercial/Industrial Structure $300 _Addition/Alteration to Commercial/Industrial Structure $200 .1. O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> i <br /> n Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> / Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> Filling/Grading $150 Boathouse $500 ° 1 <br /> mib <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> 1 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o 5. <br /> I,� r <br /> Property Owner's Name: M i C_1 10 e.I `'F" •.i-Ca n \!V a I -1'7-I n c r, <br /> Property Owner's Mailing Address: Q~]a a5 J tad- e t�10 Qd 35 (,1)ebs ✓ W Z 5 L 09 ji (� <br /> Property Site Address: W I ' t a 1 a 1 Cie r r)eSS RV PaC1tY _4 tp <br /> 1111111111.11111 Contact's Telephone Number: `�15 -cg, (tc.> - ea-7� ., .. _a r <br /> Contact's Email: Wh 1 -fetal / li.)► [Ci e r neSS @,hOfi ()lad . CO i'n <br /> Legal Description of Property: 1 r1 C\LC C9'C CAI o 00 <br /> 7 <br /> Section#: ,:2j Town#: 1 40 N Range#: f(p W Town of: OM<Ian c( o N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> r <br /> Tax ID#(1-5 digit number; found on tax statement): .3 Z/--g c4 -3 -3 <br /> Proposed Use of Structure/Addition: O ll P R rU LA. f CI 5frL► C f V✓e w x <br /> Anticipated Start Date: )mil(11e(iIa—i e, Honre/Cabin;Commercial Business;Bedroom;Deck;etc.) ^ CI <br /> Building Contractor: A//A Sewer Installer: ` I" <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY � N <br /> fo <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 /%to all COH da/4oifS 'At... . CUP— Z/- /o. z (Z w <br /> xi <br /> .- Fee Rec: 1Z5 ° <br /> N Check#:8/9 $' <br /> r l C <br /> —[ 7`� a Initials of site visit staff: D i I-- m <br /> Date of staff site visit. � � ((( > , <br /> / c Q <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/Z 72D Z47 r, rNil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N <br /> N 'Transcendent: - Page 1 of 4 ', <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 ? 113 <br /> J <br /> C <br /> 0 <br /> D <br /> N <br /> ro <br />