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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> bN <br /> Applicant Complete All Sections Below This Line a - * - . <br /> a. <br /> g <br /> Permit Types and Fees:(Please,check appropriate boxes) g. C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "I-- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 CDE <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 .�� n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 at\ <br /> n U <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250/ ° <br /> f • Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i-. <br /> Filling/Grading $150 Boathouse $500 g ` <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> 0 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> �^ r z <br /> Property Owner's Name: M t C.Y 10 C I "1- i tan 1 l W Q ( 4-7-1 Yl ci .,, _ P cs <br /> o <br /> o <br /> Property Owner's Mailing Address: rS t if e - ()ad 35 e.bs ✓ Z 5 4 9 -g <br /> , , \ ' • � City 1 _ State v <br /> Property Site Address: W h 1 i'f'to 1 1 W 1 Lie Ir 'less teL� �a r - 1-t-t 78 <br /> Contact's Telephone Number: `7 15 -r5(ect? - ea r71, E. N <br /> Contact's Email: Lt.)‘-)I tetoo ) WI 'Cif( ne55 @''Viol-(YlCU I . CO►'11ro <br /> Legal Description of Property: 1 ri C\LtC1r-CI o 00 ,` <br /> 7 <br /> Section#: 3c9 Town#: 1 yOi N Range#: f(p C W Town of: IK I a it) o N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C �' <br /> Tax ID#(1-5 digit number; found on tax statement): - 36 2/3 <br /> o m <br /> Proposed Use of Structure/Addition: C0.Cn.P Y O Lt n d 51-rLi C f U✓e. W F <br /> Anticipated Start Date: 10)(rled 1 e ty', `7Home/Cabin;Commercial Business;Bedroom;Deck;etc.) S) ° p <br /> Building Contractor: /\//A Sewer Installer: -, Q <br /> W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THISf PERMIT IS//SUBJECT TO ALL CONDITIONS LISTED BELOW: 1- N <br /> D lG (lObt7 a l/ co ti del 5`70/(S -,t4A CUP- at -/0o z W <br /> - Fee Re cL 2,(5179 <br /> Check#: $I q8.. <br /> t7 {{ti� prn <br /> Date of staff site visit: � �� Initials of site visit staff: V , <br /> z -•L- 1 I <br /> APPROVED BY LAND SERVICES OFFICIAL: ' `-i-0ATE: 07/0402- iMi <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF VW _t © <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CID 0 <br /> ?V <br /> Transcendent: - Page 1 of 4 <br /> I <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 <br /> d <br />