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LAND USE PERMIT APPLICATION - Burnett County, WI 5- <br /> Applicant Complete All Sections Below This Line F 4 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> ro <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 v R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> /. Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 IP <br /> /`- Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> rr ° <br /> Filling/Grading $150 Boathouse $500 II <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r <br /> 0. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. FS ' <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. o ot-. <br /> I � <br /> Property Owner's Name: M t(`h C1 CI `"1" •Jean \N�. I +Z 1 Yl c .� .� 9 (t <br /> J F. <br /> o <br /> Property Owner's Mailing Address: a ri Ci ai.5 S t0.-} e- "Fioad 35 We.bs-tc.✓ VI 5 493-g <br /> ', `, �1 ' , \ City tote' Lr7Zrp �. n <br /> Property Site Address: W h I y tot I W 1 id e r n e5s 1eU �Glr kt`'` �7 / " ► <br /> Contact's Telephone Number: `1 15 -2'(c(c, - e a el o C — t <br /> LOI d <br /> Contact's Email: �)h t t etc 1 I WI ICI e it' ne55 hDfi()lCU I . CO r <br /> Legal Description of Property: I tl C 1 Lt d t'GI o <br /> Section#: 2)cEk Town#: 1 I- 0 N Range#: j(p W Town of: C(XK 1 i n C' E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i <br /> Tax ID#(1-5 digit number; found on tax statement): ,i ��Z9 3 ^ <br /> Proposed Use of Structure/Addition: Co..rn p Cl,` v mO Lt n d S-rL► (-I-0✓e h,,.. <br /> vJ <br /> Anticipated Start Date: ►0)a)ejt cure, Hoe/Cabin;Commercial Business;Bedroom;Deck;etc.) \`1 5 <br /> Building Contractor: /'//A Sewer Installer: — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> O W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z N <br /> 0 fW/ G e co,►aa,f�o,ls �'irow� GU f-Z//oe -_9 <br /> � W <br /> t-N <br /> H Fee Rec: I a/52:19 <br /> Check#: kt'9g <br /> Date of staff site visit -..--t'.1 --s 6 CS Initials of site visit staff: 11'" _ <br /> C.,_-__ <br /> •r- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/Z7 ZO Z/ <br /> co W a 0 <br /> UPON APPROVAL: APP CANT MUST POST COPY OF 1 ru <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ;, N Q <br /> 1 <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 JJ <br /> 11 <br /> - <br /> 4 <br /> b <br />