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LAND USE PERMIT APPLICATION - Burnett County, WI - ( b <br /> Applicant Complete All Sections Below This Line <br /> p 4 <br /> Structure <br /> Permit Types and Fees:(Please,check appropriate boxes) t" <br /> Dwelling/Principal $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 r4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ` e <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w Ilk <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. r., "� <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. <br /> o <br /> Property Owner's Name: M(C O e I ` reCL 1'l \Nlr I +7-i Yl „ p lb Y 1 -4" •J <br /> ° 0 <br /> Property Owner's Mailing Address: e= 7(iJ tai-e -t t c ad 35 W e.bs V�r ' Z `J 4093-i <br /> , City - state z (-) <br /> Property Site Address: W, \ i t a ' I 1 CIE ( n eSS ►Q V Par --}--+} 39 4 <br /> C <br /> Contact's Telephone Number: `115 -F'(a(L> - 8 0l'740 a <br /> Contact's Email: LUh t t eta I J U..)I ICJ f tr Y)c55 @.hat Cfl CI I . Co✓tm li, <br /> Legal Description of Property: I 1-1 C i Lc d t'GI N <br /> o w <br /> Section#: 2j c; Town#: 1 HQ N Range#: J(.Q W Town of: ()CI:K I ti n(( ° N <br /> d <br /> ui <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): 3?'z 9.3 _ b` <br /> Proposed Use of Structure/Addition: C.0.rny r C Lt. rl d S{rLI C`4-L)re_ F x <br /> Anticipated Start Date: Ir"Y)O LtI Ctt'' Home/Capin;Commercial Business;Bedroom;Deck;etc.) c ° p <br /> Building Contractor: /V/f\ Sewer Installer: — -3 0 <br /> A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 fo/44.2 4// cd.tit4d.,s "" cuP- z/--/o, z "qo <br /> po C\ w <br /> k <br /> - Fee Rec: 12,0 <br /> N Check#:W <br /> ff rm <br /> Date of staff site visit: 6 l J)Ems^ ,6 Initials of site visit staff: <br /> 7.1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/ /zzv a! Em <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF IR T f <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> '" 0 <br /> iiP. I <br /> Transcendent: - Page 1 of 4 g� <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 In <br /> ,...2)n <br /> Y <br /> 4 <br />