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LAND USE PERMIT APPLICATION — Burnett County, WI 5- g <br /> t~ <br /> 0. <br /> Applicant Complete All Sections Below This Line 5 <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Q� �O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �� rD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o <br /> f• Driveways/&Campground Structures $125 _WI State Statute 59.692(1v)Structures $350 �. ' <br /> ' Filling/Grading $150 Boathouse $500 <br /> lin <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 a'a Is <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r., g <br /> 0 <br /> p MIChQ el lean Via ( +Zi n z <br /> Property Owner's Name: "�" C� <br /> r P <br /> °o c*i <br /> Property Owner's Mailing Address: a'7 c,a5 S+a-t-e_ 2 o ad 35 Webs-tic. VI_ 5 40vic <br /> t <br /> ', '' .\ ate <br /> Y • w y <br /> Property Site Address: W\\t11+ 'a i I a); de r nesS g.0 Par Leyt sg x <br /> Contact's Telephone Number: r7 i 5 -R(p(c, - ea 74, \ (` a <br /> Contact's Email: Li.)h I t etch, I U)I ECk f reSS l hcs-t-rnOu I . Co►'1'1 \�" co <br /> o <br /> Legal Description of Property: 1►"l C k u CI r CA N 00 <br /> Section#: 2j col Town#: 1 40 N Range#: go W Town of: C)ra_K1 a.r, o <br /> t7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> R <br /> Tax ID#(1-5 digit number; found on tax statement): 3629 <br /> 3 <br /> Proposed Use of Structure/Addition: CCL(n.��r011 -b round s -u r*U ve w -I x <br /> Anticipated Start Date: 11\iiledi C -i e Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N ° — <br /> Building Contractor: A//A Sewer Installer: — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY1. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> OF/t/o/A) 4// coticZAo0 s 'fit^^ C UP-u-/ '. z <br /> H Fee Rec: I2 <br /> 7' Check#: Y <br /> a � <br /> Date of staff site visit:6,---- t� 6 Initials of site visit staff:_ tqiii114-- --- <br /> VZ /"�oZYAPPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> �.--���J <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF V co a �(��]] <br /> -.3 —� V V <br /> Oco <br /> 1511 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �: <br /> Transcendent: 1 <br /> Page1of4 IN <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 1 11 <br /> l l , <br /> ` J <br /> Y <br />