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LAND USE PERMIT APPLICATION — Burnett County, WI a t- <br /> b <br /> Applicant Complete All Sections Below This Line 5 <br /> 0. <br /> c -` <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '� ocl <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 61 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 q <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <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 <br /> 0 <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. -o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t-- gn <br /> Ufa <br /> 0 <br /> Property Owner's Name: Mt C VI C1 �,I * Jean fa I +Z I n �, 1 ` <br /> o <br /> Property Owner's Mailing Address: )17 c asj tiJ-e L 1(o ad 35 )e bsi r /7 I43" <br /> '' ', \\ City Stat F <br /> Property Site Address: W h t f�fia t I LI.)1 Id e r 1')eSS R V� Va r t- ;��, k ^ <br /> o N P <br /> Contact's Telephone Number: rs1 15 -S'&co - e a'7cc, a <br /> d <br /> Contact's Email: t 2h t t P_.ta.t J l/)1 Icit r ne_ss Out mai ( . Co ry- —s) v <br /> Legal Description of Property: I r1 C 1 U.C`t'CI N vo <br /> 0 <br /> Section#: 3;1 Town#: 1 '--IC N Range#: (LI W Town of: CykK I a r)G( o <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): .,-+ , 7/t 36Z?3 <br /> Proposed Use of Structure/Addition: C.a:M P'-(Home/Cabin;(0 Lt. Y�C� S{-rl) (+ L)re_ .. w F <br /> Anticipated Start Date:_( 1')flle'L t I C.( f, Commercial Business;Bedroom;Deck;etc.) V <br /> , u <br /> Building Contractor: /V'// Sewer Installer: — - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY b ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:�-r�//ov <br /> 0 a sr:, st -�// co ' f',q � CUP- it -A0, z • <br /> H Fee Rec: /Z/5170 <br /> Check#: g'lQg <br /> Date of staff site visit: b ^tb r--t °9- C-:-' Initials of site visit staff: L M 1� r <br /> y, <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/ ZDZ-Y "� <br /> : _ M <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF a <br /> < 3 -< <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT • a o ,�, <br /> Transcendent: - Page 1 of 4 '`` <br /> 3 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> .)J <br />