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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line a <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) = Q <br /> Li <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $2005t 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 /> 0 Nib <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692 1v Structures e <br /> Pg ( ) $350 t <br /> Filling/Grading $150 Boathouse $500 b <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cA <br /> 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. -o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> Property Owner's Name: M I C.h CI e I `+ .J to \A a I -f'Z-1 a <br /> a <br /> I o 1 <br /> Property Owner's Mailing Address: a'i Ci as J t(If e- Plo act 35 (,fie-409 <br /> � `` � ' .\ City State t E. <br /> n„ <br /> Property Site Address: Lv h I+e to i i W 1 Id e r n esS 1:v Par -t- -'—�' 3 <br /> 0 <br /> Contact's Telephone Number: i 5 (c(� ' 7� - ' a <br /> d <br /> Contact's Email: (�h 1 t eta i I l.t.)1 l cl t( ()C55 @ h nl CU I . Co m <br /> IC <br /> Legal Description of Property: I r i C IL(t Cit.'CAI N <br /> o� <br /> Section#: 2 Town#: 1 I-4D N Range#: ((p W Town of: ()rLK I a r) o <br /> u. <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): Tel, 36 Z/ 3 <br /> Proposed Use of Structure/Addition: (7_0.rn t'C-Y 0 Lt n d sly/ I p*U V e W H k <br /> Anticipated Start Date: lr�l(e cifCt_i-e --el-low/Cabin;Commercial Business;Bedroom;Deck;etc.) 1� 1 ° — <br /> Building Contractor: A//A Sewer Installer: — -s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> á / //ot3 (Id C0 74d� -G29 ct/- a/-/ 70 z <br /> po <br /> .I Fee Rec: )Z,.Pv <br /> N Check#: $/9R <br /> �/ C <br /> Date of staff site visit:6"----k--7'���6 Initials of site visit staff: V i--- M 1"— y <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / 7/ a <br /> / c <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF MI <br /> p f o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i µ Fill <br /> o <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> L� _(fill <br /> y JJ <br /> ro <br />