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LAND USE PERMIT APPLICATION — Burnett County, WI a 2 f~ <br /> b <br /> Applicant Complete All Sections Below This Line . 0 <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 - 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 "`l 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 -N..... <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C, ^�0 <br /> Filling/Grading $150 Boathouse $500 P <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 gl)v - <br /> ° r. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a — <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. t-. <br /> 0 <br /> z <br /> Property Owner's Name: MIChaeI * jean \A/a I + z I n o <br /> o <br /> Property Owner's Mailing Address: a ria a5 5tat e ?load 35 ebs-cv V/I- 4 i97a <br /> LA--) <br /> ,, \\ ' .\ City tate Zip E. <br /> W <br /> Property Site Address: h 1 f e to 1 I W 1 Id e Ir e s 1(QV Par . Lot. c78 3 E <br /> O y <br /> Contact's Telephone Number: r]i S -R(a(L, - g 317‘.,, O. Q • 6g. 0-- <br /> U n, <br /> D <br /> Contact's Email: Leh I f etCt_I I U.)I ICI e it 17e5S OD h fCI I . CD al <br /> Legal Description of Property: I t 1 C l t d GI v o 00 ,� <br /> g P P rt': <br /> Section#: -2j c Town#: 1 L4C) N Range#: f(D W Town of: ()(1 K.I(a in(4 v N <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): 2 Q .? Z/ 3 r„ <br /> Proposed Use of Structure/Addition: XLcn q CO LL n d si-r-U l`.f1J(� �/�► x <br /> Anticipated Start Date: 10)(11 ed 1 et tP Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (� N ° p <br /> Building Contractor: i\//A Sewer Installer: — I <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 io/%iJ Q// Ctox CZ 4 re s -Fm 1M CI 4 —2/—/oe z Q <br /> Fee Rec: IZ . <br /> N Check#: e <br /> 1)1-likA\1— <br /> Date of staff site visit: 6 - 16, �O,; . Initials of site visit staff: m <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / / TOrd <br /> Q > <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <.J r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r- ^J <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 .' <br /> ; J <br /> ro <br />