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LAND USE PERMIT APPLICATION — Burnett County, WI a-a r <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `14 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 X O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 rP <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° g- <br /> /• Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. �(' <br /> oI. <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r <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 0. <br /> Property Owner's Name: M I(^h 1/ e..I `"�- J-eC111 �a -I'-z_a' <br /> f1 z <br /> Property Owner's Mailing Address: a'a 5 v tad Road 35 Webc- V.L. 5L4 93 a <br /> ', '' \\ City tate E. <br /> W <br /> Property Site Address: hife totI WI idernesS ►e.V Par ( z,-i•-. '7 <br /> Contact's Telephone Number: �5 -�'(� - 8 a�� � � a <br /> � <br /> o <br /> Contact's Email: LA)h t t efiCt.i J 1.1)I ICI-e r i7e5S @ hCit(Y1ou I . CO n'1 <br /> Legal Description of Property: In C I u C, CI oo N <br /> Section#: 3(9\ Town#: 11- 0 N Range#: J(p W Town of: 0u.K.I(l in(4 d �' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> R <br /> Tax ID#(1-5 digit number; found on tax statement): - 7 / 3 <br /> u 6 1? 3 <br /> Proposed Use of Structure/Addition: C OXn (O Lt_Yl C( S{-r-u (`_f Li Irk W x <br /> Anticipated Start Date: 1{1)mecti C(±e Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° p <br /> Building Contractor: /\//A Sewer Installer: -I c ) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 01 //o� Cfl/ ce"I / nos �� ��P- a ,e , z <br /> w <br /> H Fee Rec: /2/0o <br /> Check#: $l <br /> � �1 — c <br /> Date of staff site visit: l: I _ 0 s f <br /> �' Initials of site visit staff: rn <br /> C I I <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/ZS/�Z� �` <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 4 �Si Si n <br /> 'rl c: 0 <br /> n ill/ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r c > , <br /> Transcendent: - Page 1 of 4 ' N <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 a2- rifil <br /> o <br /> i <br /> ro <br />