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LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> Applicant Complete All Sections Below This Line Z ii -NF <br /> a <br /> NI <br /> Permit Types and Fees:(Please,check appropriate boxes) 0 K1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ` O <br /> • g <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 <br /> P <br /> , Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> /\, Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 d b <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. I CI <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. --0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- t, <br /> z `. <br /> Property Ow n 'ec,Owner's Name: I v 1 -4- i ea0 e.1eal' \V v c1 I -I-Z I n ci P i <br /> Property Owner's Mailing Address: c)'](i as s tt1 t f to ad 35 I,0eb5 cv VI 5 4 39 <br /> ', ,, \\ I ,\\ I City 1 _ toe <br /> Property Site Address: W`1 I f-eta 1 i W 1 Ici e r n e5S RL1 Par' L-Cri-`A `-) / i <br /> Contact's Telephone Number: `7 15 -F'(c(n E a 7(0 '� o 1 r <br /> a <br /> Contact's Email: Lam)h► f e.tcx 1 i w 1 [Cite r 17e55 j ho t Mai 1 . CO►Y Y <br /> Legal Description of Property: 1 tl C t Lt.d t?0 oo %. <br /> Section#: -3 3 Town#: 1 4C N Range#: J(0 W Town of: Oal<1 an ri d N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): —> j 3 'Z.?3 <br /> Proposed Use of Structure/Addition: C0.rn P�Y`-D Lt. Y1G� Si"rLa (`1-ore_ p <br /> � <br /> Anticipated Start Date: l0rn mCd(C- -1-e Home/Cabin;Commercial Business;Bedroom;Deck;etc.) n N e• <br /> Building Contractor: A//A Sewer Installer: — \v Q <br /> - 1 W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a ` <br /> �l Q <br /> nn z <br /> Q Fd>'�ea,, a c©� oqS -tom CuP-Zt' -/d. W <br /> Fee Rec:(Zj 5e9 <br /> 1�? nLi V - <br /> y Check#:$'/99 <br /> Date of staff site vis / <br /> i ~_ �` Initials of site visit staff: r r <br /> r'" <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:3t/g7?-49Z/ �� <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF Ac <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 00 a Fillc 1=1 <br /> Transcendent: - Page 1 of 4 ''. I <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 m <br /> ro <br />