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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line "' <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) - 47 <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 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o I. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 �- <br /> Filling/Grading $150 Boathouse $500 b <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 m <br /> 2 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -a <br /> rD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r -. <br /> r o .. <br /> z <br /> Property Owner's Name: NA(C KO e.I `'1" J- Q rl \ila a I +-i I n ei -, 0 ,II. <br /> °o <br /> Property Owner's Mailing Address: a`7 45 S tccl-e- ?load 35 Webs-icy- VI_ 5 4g93� <br /> Property Site Address: W 1 a I 1 d e r n ess ►°�U Party L_gilim 5 '' <br /> o Contact's Telephone Number: 17 15 -S(, (c., -- 8 a'-i a 1 <br /> n/ � .0 o , <br /> Contact's Email: jh t t e.tc 1 1 l t)1 idd-C d- r)ess Oct mai I . CO r1'1 <br /> 'r <br /> Legal Description of Property: I CI C IA1 [ CI 0 w Cl <br /> Section#: c9\ Town#: 1 1- O N Range#: f(p W Town of: Or K I a n a d N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systemproperty page.* q. <br /> Tax ID#(1-5 digit number; found on tax statement): 6 <br /> 93lc a 93 <br /> Proposed Use of Structure/Addition: C-0.rn Y D(l Y1 G� `�{"rL,i U re- ` iv <br /> W x <br /> Anticipated Start Date: It (1'ea 1 CC-f-e • Home/Cahin;Commercial Business;Bedroom;Deck;etc.) n, p <br /> Building Contractor: /\//A Sewer Installer: — 1 v <br /> A W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (T' b1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: "4$ (v <br /> 0 fo/%ow ill coptc4Woifs f►-oiA". CUP-a - Oc. z k s <br /> x <br /> -I Fee Rec:)Z,519D <br /> N Check#: g)4 8' <br /> Date of staff site visit: Cy-- / Ct`� � 6� Initials of site visit staff: ��- r v`� mT. <br /> 4 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/Z/ZD ZV 1- r---- ""-� <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF r co <br /> Fill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Do:(11 N o <br /> $1) ^' N 1:: <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 Ill <br /> 6 <br /> ro <br />