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— LAND USE PERMIT APPLICATION - Burnett County, WI <br /> ca. b <br /> Applicant Complete All Sections Below This Line 0. 8 <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W 0 \\\ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 I" <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> / R. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 (Q ' <br /> Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 iv <br /> • <br /> • <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. p <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. .v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> 0 <br /> z <br /> Property Owner's Name: `^( Ilk <br /> p rtv M1Chc� el J�'c�n \J�C1 l +Zi n �, <br /> O_ 1 <br /> Property Owner's Mailing Address: a'7 a 5 J tout-e (F ad 35 (,()eb5-It ULL 1-1- 9"'.o <br /> City State Zi �. <br /> Property Site Address: UD h I f to I a L..A\1 Id e r n ess 1AL' Par Lot. '7 \ <br /> Contact's Telephone Number: '7)5 -P,'(,2(c) - e a'7So <br /> L ., <br /> d <br /> Contact's Email: L>Jh I t eta.' I U.)I iCkk d- I')e55 hOfi fYlCU I . Co rr <br /> F - 1 <br /> Legal Description of Property: I n C\l.t de c o 00 <br /> Section#: -3(9\ Town#: 1'-40 N Range#: f(p W Town of: CCLK 1 a n o N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> � <br /> Tax ID#(1-5 digit number; found on tax statement): 1 36 5 3 z93 <br /> w <br /> Proposed Use of Structure/Addition: C..O.-cn P R Y`-0 L1 nd SIT-Li ('f ore_ w .;-3 x <br /> Anticipated Start Date: l'�rl(112Ltt O.—t-y, Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 't V ° p <br /> Building Contractor: /\//A Sewer Installer: — -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O AS\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S N <br /> 0 f ,/#00 «/I co aci;4aa 5 -64,04 cup°-Z,-/o. z x <br /> x Fee Rec 1�2/c <br /> M Check#: g j i g <br /> 7 � <br /> Date of staff site visit: camG` Initials of site visit st �— �� <br /> APPROVED BY LAND SERVICES OFFICIAL: /v`' ~ DATE: 3 Z// zfri ow <br /> o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W <br /> 4o N m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i i <br /> N C4 <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 LL JJ <br /> v <br /> H <br /> -o <br />