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LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> Applicant Complete All Sections Below This Line a• y• V <br /> .7.-_ <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> rD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure �$300 Addition/Alteration to Commercial/Industrial Structure $200 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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> 7 Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i- <br /> ' Filling/Grading $150 Boathouse $500 '9 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w ilk <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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r, g <br /> Property Owner's Name: ^ <br /> P m- MIC.h� el `�- Jean \�� I ��-I11� �, <br /> Mailing c r7das Sto±e F cad 35 Webs-tc 54093°-ET <br /> PropertyOwner's Address: � <br /> , '' 11 City tate = n <br /> Property Site Address: W 1 to t I 1 Cie 1r ( SS 1`2V Par -►--+� ci A <br /> o <br /> Contact's Telephone Number: 17 15 - &to - e a'7(.,, a / <br /> Contact's Email: LA_)h I t eta, U_)I Id t ir I)eS5 Oct C ICU I . co rim n <br /> I <br /> Legal Description of Property: (r1 C‘Lt.c t Gi o on <br /> 0 <br /> Section#: .:2j(9 Town#: 1 HQ N Range#: RD W Town of: ()(ELK I a n 7 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): 713 e j ,3' 2-q3 <br /> c, <br /> w <br /> Proposed Use of Structure/Addition: C.0.rn P�Y_U Lt. Y1G� S{-rLa r-I-U✓'e. � W � k <br /> Anticipated Start Date: lf11(i)€t�(a t-e Honie/Cabin;Commercial Business;Bedroom;Deck;etc.) (� N 3 C7 <br /> A <br /> Building Contractor: Ai/ Sewer Installer: — ) <br /> A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: A N <br /> a fo//ow d cz.p.')4oA -Pyoi1 cuP-za z <br /> w <br /> N <br /> -, Fee Rec: J Z 5O <br /> N Check#: $/?Sr <br /> -) C <br /> Date of staff site visit: ' - l [ ^ o Initials site visit f: � � y , <br /> �OJ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 0. Zo 24/ <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 41 f 0 <br /> SIGNED PERMI <br /> T APPLICATION IN PLAIN SIGHT cb a ^, <br /> Transcendent: 1 1 t <br /> Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> 4 <br /> b <br />