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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 5 <br /> F. N <br /> c---- <br /> Permit Types and Fees:(Please,check appropriate boxes) F r <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W O <br /> Accessory Structure(Garage,Shed,etc.) $150 _Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 to <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 7 <br /> /` <br /> ' Filling/Grading $150 Boathouse $500 V <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 Ln <br /> 2 ft <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 /> cD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- J <br /> o <br /> z 1 ` <br /> Property Owner's Name: M(C,h C/ e_I '-1-- ---)ton \Afa I +Z I n ci -,, ,\ <br /> Property Owner's Mailing Address: cQ17 C-a..5to.. e- Plc ad 35 LWJebs-tCic VI_ cJ i-4- 9:3-8- <br /> Cit� l,O State <br /> E. <br /> Property Site Address: White �'Q 1 Id i� (Jess V`V Par -t`'a T P <br /> O ti , <br /> Contact's Telephone Number: r7 15 -fc'?'(c-(c - 8 a.7(.,' \ N` E.' f4 <br /> Contact's Email: �)h i t E�t c, i I U_)I ICik( neSS t alai! h6 I . co I1'1 N. <br /> o <br /> Legal Description of Property: 1 tl C.I t,t Cl r'Ci N w <br /> 0 <br /> Section#: 1j c , Town#: 1 t-4D N Range#: f(p W Town of: C Ti K I an Gr! . N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 77 <br /> Tax ID#(1-5 digit number; found on tax statement): `i5-6 5 - ‘Z9 <br /> Proposed Use of Structure/Addition: C.(:),CII t'ct Y`-D IA n GI SiY'1,l (`*l)✓e_ 1 W k <br /> Anticipated Start Date: l Y Y)i71 f'CU U a-t-e Home/Capin;Commercial Business;Bedroom;Deck;etc.) ° p <br /> Building Contractor: IV'/A Sewer Installer: — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT ISSUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> e Fo//o al/ Ce�44ois lAr% C -zi/o0 z <br /> x w <br /> H Fee Rec:ILjo <br /> FA Check#: 97,8 <br /> G —f6'— j � 1� <br /> Date of staff site visit: ® Initials of site visit staff: � r <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: Y Z�/ZOZ� r <br /> u <br /> 9 __.--) <br /> ci u� <br /> UPON APPROVAL: APP CANT MUST POST COPY OF 0 <br /> 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Z. N o <br /> "" I rz <br /> Transcendent: - m `` <br /> Page 1 of 4 3 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 7. Ili <br />