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LAND USE PERMIT APPLICATION — Burnett County, WI 0. <br /> Applicant Complete All Sections Below This Line '6' ti <br /> F <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '' CIO <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� �, — <br /> . Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> /, Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 \. <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <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. �-. 5. <br /> 0 <br /> , rr <br /> Property Owner's Name: M 1 C h 0 t I `'1" -J ton \NC I f -I n o <br /> 6 r <br /> o <br /> Property Owner's Mailing Address: a r] -fat e - o ad 35 Webs-tic VI_ 54 9joa- <br /> , , \\ ' .\ �tv City State Zip E. <br /> Property Site Address: W I fei'Q t I W 1 I r n CSS IQU Par `A 3„{ , <br /> '� o N <br /> Contact's Telephone Number: i7 15 -h(v(n - E d 7c a <br /> 41, <br /> Contact's Email: L h 1 f et-al I up ictc►� tress @.h6fi n'1CU I . CO t`Yl —C) d v <br /> Legal Description of Property: In i C 11.t CI c ci ogo <br /> Section#: ?j ck Town#: 1 yD N Range#: J(o W Town of: C)ri i I a n G( o N <br /> 0 <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): c-!3 <br /> p C0.rn Y OLtfC( S-k-rL.I (.-U��. W F 5 <br /> Proposed Use of Structure/Addition: `� <br /> Anticipated Start Date: 10)medt cci-e "—Nome/Cabin;Commercial Business;Bedroom::Deck;etc.) 1 N -6 <br /> Building Contractor: A//A Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> N <br /> 6/0/4to ail eo pi c44e s -Gv wl G(4,- z/- z/O° z W <br /> - Fee Rec: el 5V° <br /> 1 Check#: RVgS" <br /> Date of staff site visit: 6 O r-. 1 6 4 �e, Initials of site visit staff: \)�- <br /> til <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3A-8/00 241 x a, — <br /> J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF F, ( A 0 <br /> '71 CD 7. fill <br /> u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 7 0 N �, <br /> �� <br /> Transcendent: - Page 1 of 4 m eff 1 Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 a 2 <br /> y <br /> b <br />