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LAND USE PERMIT APPLICATION -Burnett County, WI 5- g <br /> Applicant Complete All Sections Below This Line F % <br /> a <br /> r_ <br /> Permit Types and Fees:(Please,check appropriate boxes) O G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 •Ii <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N. n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150lb <br /> n p 16 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < N <br /> Driveways/&Campground Structures $125 r, <br /> _WI State Statute 59.692(1v)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 p <br /> *NOTE:After-the-fact permits(permit aquired 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. o 5 <br /> n � ` . r z <br /> v <br /> Property Owner's Name: I I C 1'10 e.I `-f- - Q W r� I +Z I n ci <br /> -n o <br /> 0 <br /> Property Owner's Mailing Address: a r]c),as S taf e t�i0 ad 35 (.,1)e last.' 93 <br /> City State Zii = n <br /> Property Site Address: I+ a t I 1 d e tr n ess t`2V Par "t"--1.._ <br /> Contact's Telephone Number: `-1 15 -g(can 6 a'74 o a - <br /> 0 <br /> Contact's Email: L )h► t e tCl u / l�I idf.V- r�e55 ' ,h ()lad ►• CO M 411, <br /> Legal Description of Property: I rl C‘U d e ci o 0 <br /> B <br /> 5 <br /> Section#: 3 c: Town#: i HD N Range#: R(p W Town of: OaK 1 a n(f oc N <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy offthe deed OR attach tax system property page.* <br /> 3 7_ <br /> Tax ID#(1-5 digit number; found on tax statement): 4 5 3C2-ax <br /> Proposed Use of Structure/Addition: C.0.rn 1 C� `� <br /> r0 Ll.Yi"Y1.1 (`-Fore,✓� -1 w <br /> W F x <br /> Anticipated Start Date: 1,(tlrrledl C(t'f, Home/Cahin;Commercial Business;Bedroom;Deck;etc.) n (� p <br /> Building Contractor: A//A Sewer Installer: — \v H `' <br /> \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> n f�do, a // cePta 4A'S 40M CO,— 2/-0, z <br /> H Fee Rec:11/Z,5190 <br /> Check#: 8/9$ <br /> mi <br /> Date of staff site visit 1 / c9•0cc Ini ' s of site visit staff: Ni,AA,iz--- <br /> a U <br /> 27 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 ZOZ r1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF IW f CSC <br /> Kil <br /> SIGNED PER <br /> MIT APPLICATION IN PLAIN SIGHT o N <br /> q I Q <br /> Transcendent: - Page 1 of 4 1 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 W <br /> C L� J <br /> 4 <br /> b <br />