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LAND USE PERMIT APPLICATION — Burnett County, WI g r <br /> a "V <br /> Applicant Complete All Sections Below This Line 7 <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> f, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ <br /> Accessory Structure(Garage,Shed,etc.) $150 —Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> 7 Driveways/&Campground Structures $125 _WI State Statute 59.692(1v)Structures $350 r— <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 (. 16 <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. t- g <br /> 0 <br /> Property Owner's Name: M I C h CI C I -4- J ea r> \ila I4-7-in ° C-- <br /> oo 10 <br /> Property Owner's Mailing Address: c)~]t5 a5 J tat ['load 35 W e.bs ✓ W Z_LJ 4g93 <br /> '' ' . \ City -. 5. n <br /> Property Site Address: W,, ``h I f L�'Q t I W 1 Lie r n C.SS 1i.0 Par _4 6' <br /> r y <br /> Contact's Telephone Number: `7 15 -g(o(L, - ea 740 a <br /> Ue, he O ' g <br /> sk <br /> Contact's Email: Lamh I t e tc 1 I L I IC` t Y)C55 0' 1 "LA-1 I . C t 11 Legal Description of Property: 111 C 1 t-t d C CI o 00 <br /> Section#: 3�� Town#: t 1-40 N Range#: f(p W Town of: caK`a �(h ,, N <br /> o <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): 3 2,9 3 r, <br /> �, <br /> 1� 1 p <br /> Proposed Use of Structure/Addition: C.C�rn t' Y p j t Yl GI `�{"rLa (�-Fore_ W <br /> Anticipated Start Date: 1(1)(nect,t&t ', Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 5 <br /> Building Contractor: /V/A1 Sewer Installer: -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY j 3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> !" / o LA) G// CtO A CM�i(o YI S -eho )./k C U ►°-21-/0., z <br /> x 10 <br /> -, Fee Rec: I Z,, 0 <br /> N Check#: 3/9'p <br /> b _ j-lvt <br /> Date of staff site visit: <br /> �'6 . � Initials of site visit staff: <br /> 7 <br /> d <br /> 0 CD <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/�/ZOa <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF ' z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 CD <br /> 0 amnia If iiii <br /> Transcendent: ;-S e� o <br /> Page 1 of 4 8 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> ro <br />