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LAND USE PERMIT APPLICATION — Burnett County, WI tg <br /> Applicant Complete All Sections Below This Line 0 <br /> c� <br /> Permit Types and Fees:(Please,check appropriate boxes) _ 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � /Q� <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 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n V <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 '1 <br /> 0 Ilk <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. 1 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-- 5' <br /> r I z c <br /> Property Owner's Name: M I C.h 0 e I `� •.�to rl \!V a 1 +7_1 Yl ci -n o <br /> Property Owner's Mailing Address: a r]C�a5 J ta±e_ trio ad 35 Webs-tc' L 5 4093a <br /> ' A f City State i n <br /> Property Site Address: W h I f to 1 I .`1 Id e r 17 CSS IQv Par- -t`*'' Jc. K <br /> '— '''' 4- <br /> Contact's Telephone Number: `-1 i 5 g( ea 7(o a <br /> No <br /> Contact's Email: u_ h 1 't e.tat I lo 1 lc(k ( i7C5S ,VI rnct.0 1 . Co ►)Th 10 v )' <br /> Legal Description of Property: In C 1 t,t Ci t GI o 00 1� <br /> Section#: ,j c Town#: 1 4O N Range#: ((p W Town of: or-1K 1 a n G( Q0 N <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* EL <br /> Tax ID#(1-5 digit number; found on tax statement): •i,j 3g Z9_3 <br /> Proposed Use of Structure/Addition: c_arn J co Lt n d S{-rLa (`-U re 1 W x <br /> Anticipated Start Date: 10)rneJt(a 1-e Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^ p <br /> Building Contractor: /\//A Sewer Installer: `Iv _, <br /> , ,,, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> 0 f ct,J q// G57t4440 'TrOI-& Cu P-ZI-/Q. z**---... \ -o <br /> W <br /> 6\ <br /> Fee Rec: I Zj S )O <br /> Check#: $/9 <br /> \ �� 'NI— <br /> "� rri <br /> Date of staff site visit11 '� ad V Initi of site visit staff: r , <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: yzyz,zy f IM <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF a W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i" ^� <br /> is <br /> I .:: <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> C <br /> Y <br /> t <br />