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LAND USE PERMIT APPLICATION — Burnett County, WI cr <br /> Applicant Complete All Sections Below This Line 5' 7 <br /> n 1 <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) O Gl <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 kl). <br /> c/ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> F <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150IIP <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 t-. <br /> Filling/Grading $150 Boathouse $500 g <br /> N <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 c <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. 0 r <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i-- 5 <br /> Property Owner's Name: ! I\t c,h 0 t 1 `'l )t.CL Yl W a. I +Z► n 0 1► <br /> Property Owner's Mailing Address: r '7 I-- ta+e Fla ad 35 W e bsi v v' L 5 Lf 9 <br /> , , \ }� d w n <br /> Property Site Address: W 1' i I O. I I . r e V'- n esS t:�J PartK 4_4,1- 0 '' <br /> o y ,_ <br /> Contact's Telephone Number: `,j 5 -S(C(n - e a'7‘., a <br /> e <br /> Contact's Email: L.L)1c)l t€1 C.l l i 11J► Id tr V)e55 @ hofi Mai I . CO n'1 -0 <br /> Legal Description of Property: I rl C\Lt C`t'CI N o0 <br /> Section#: -2j c Town#: t 1-4O N Range#: f CO W Town of: n 1K I a n C( G <br /> d <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): —1-.e39tt 3 4 Z !tt 3 <br /> Proposed Use of Structure/Addition: C,.0.tM.P 1 1 C FOB. r'1 d S{-rL1 (`-I-L)ire W H <br /> Anticipated Start Date: la)Med. a 1-f, Home/Cahin;Commercial Business;Bedroom;Deck;etc.) N ° p <br /> Building Contractor: /V'/,. Sewer Installer: — \\) -i 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 5 -;l/vcc) a// COMIA7iff cypwt cUP- ZH -/O, z <br /> \ � w <br /> N <br /> -- Fee Rec: IZt5nv <br /> 7 Check#: g(91l <br /> Date of staff site visit: (I) � ]� C11b'+9-d..3 �' Initials of site visit staff: `""\,� <br /> ni <br /> d Ir- -. 1 ' <br /> /��� r r- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 wIiiiii <br /> 0 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF it! .ca3 ?'•<' © <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o ^" <br /> Q <br /> Transcendent: - Page 1 of 4 m <br /> aserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> y <br /> C J <br /> ro <br />