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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> a <br /> ' b <br /> Applicant Complete All Sections Below This Line . a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ''c\` Cy <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 k 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 .�Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °n <br /> l . Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �-. <br /> 9 <br /> Filling/Grading $150 _Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> m <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. r- .- 'm'' <br /> r z L.- <br /> Property Owner's Name: M IC h Ci e.I `'(" Jean \A I +71 n Gl , <br /> ( , <br /> o <br /> Property Owner's Mailing Address: a 17 t)asS tat e., -Flo ad 35 We b5 f VI- 5 LI 8 73. <br /> '' ,, A\ City �.• F2' <br /> Property Site Address: 1, 1 H I f,v 1'a I I W 1 id e r r)e55 RV Va r ' c' <br /> O N <br /> Contact's Telephone Number: r7 15 -g(G(.0 - e a'7� a T <br /> Contact's Email: t J UC'1-e h I t eta.' i )1 I i( ►')eS5 hot r ncu I . Corr -.0 <br /> Legal Description of Property: In C 1 Lt C e al oo o <br /> 1 <br /> Section#:_3 Town#: i 4O N Range#: J(L) W Town of: Ocix 1a 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.* <br /> �. <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> 36z93 <br /> Lamp p co Li rl d ` IG <br /> Proposed Use of Structure/Addition: .� "rLl (`*(�1'e� t, ;� <br /> Anticipated Start Date: 1 )enedI OC fif, Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t = 5 <br /> Building Contractor: A '/A Sewer Installer: — r `3 <br /> O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS S UBJECT TO ALL CONDITIONS LISTED BELOW: �^ <br /> Or G o//e t 0// rtQ' / ,4dNs tM CUP-Z -/De z •0 V <br /> kW r , <br /> Fee Rec: 121929 <br /> j Check#: Slig. <br /> Date of staff site visit:6 —tIr ,--?e e) Initials of site visit staff: ��/ MIL-- <br /> ? l J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/ zoZY .co <br /> r <br /> UPON APPROVAL: APPL .CANT MUST POST COPY OF '''W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTIV <br /> q .::: <br /> Transcendent: Page 1 of 4 N <br /> w <br /> it <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 'a <br /> 4 <br /> Lc ) <br />