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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Linelit <br /> fa <br /> Permit Types and Fees:(Please,check appropriate boxes) F <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 _Addition/Alteration to Commercial/Industrial Structure $200 �1. 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 IICt <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n V C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 I-. <br /> Filling/Grading $150 Boathouse $500 b <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v . <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. -0v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-. <br /> r 0 <br /> Property Owner's Name: M I CY 1 C e.( `"" -J€ i n \lV a- I +Z i n 0 [, <br /> Property Owner's Mailing Address: ar]c a5 J ta-}- _ f W 10 ad 35 e.bs it- VI_ 5 4 93 <br /> I '` City tate <br /> Property Site Address: L.-0h I f t a l l W t Id e r r)esS !Q U Par -I- 35 <br /> Contact's Telephone Number: `-I() ( (L, e-4., - a. <br /> Contact's Email: t V)I t e tc I / up I Idt( heSS ►hit (YlCt,1 I . Ce►'Yl 'D o <br /> Legal Description of Property: ICI C 1(.t CI e CI o w �� <br /> Section#: 3,)\ Town#: 1 1.4) N Range#: f(p W Town of: o(`A_K 1 a h cf o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach taxta system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): *-/-4- 3 6 z/3 <br /> Proposed Use of Structure/Addition: C_C xn p ott t'O Ll Yl C( Si-r(,) (`-I"U✓e W F x <br /> Anticipated Start Date: ►r'11mecii C(t-e, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 (�� 3 p <br /> Building Contractor: Ai/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: Q <br /> D /o// GO q t// Go sy ioirs wf GU la- 2//Da z Q f�"` <br /> 1....N <br /> I <br /> N <br /> H Fee Rec:/4. 0 <br /> N Check#: go: <br /> /' C <br /> Date of staff site visit: l� ,�` Initials of site visit staff: ����� <br /> '�y .J l J <br /> i <br /> APPROVED BY LAND SERVICES OFFICIAL: -DATE: ��Z4` E _-. <br /> a. <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 5 t © <br /> il <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �� Pi., G <br /> Transcendent: - Page 1 of 4 1 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> L J <br /> ro <br />