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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a. <br /> Applicant Complete All Sections Below This Line 5 F t <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) u <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 4... <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o • <br /> j Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> _.'c., <br /> ' Filling/Grading $150 Boathouse $500 ^ p <br /> 1 <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. 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. r-. rl <br /> 0 74. <br /> Z <br /> Property Owner's Name: M I C.Y 1 O e.I -i- -__ t'_CL Yl Via L+Z I no Z <br /> Property Owner's Mailing Address: c:'7 f)45 S ta.-t-e_ tale ad 35 b -tom 5 4 89-;a ~ , <br /> , `` � A City tate dip �. �„ <br /> Property Site Address: W 1 - to I I i t d e it r~)ess v Par - ` i ( <br /> C <br /> Contact's Telephone Number: '1 15 -f Co ._ i✓a`7(o �. • a <br /> N __,. <br /> l <br /> Contact's Email: 3h I t e tCl I i li)► I tr 17C55 '@_hOfi ICU I . CD ►'1'1 —0 v rl <br /> Legal Description of Property: ►CI C 1 Lt Ci t d N Co <br /> Section#: 1j,- Town#: 1 40 N Range#: f(n W Town of: C)(i K I c n o <br /> u. <br /> N <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): ?j CD Z'7'3 <br /> Proposed Use of Structure/Addition: C.C7_rn p C co LI. n GI s r(.) C 1-U ire._ vJ H H <br /> Anticipated Start Date: 1(t TeJ{(a-i--e, -�Honte/Cabin;Commercial Business;Bedroom;Deck;etc.) ^, (J p <br /> Building Contractor: /\/"/A Sewer Installer: — \" -� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ...Z. R <br /> THIS PERMIT IS SUBJECT TO1 ALL CONDITIONS LISTED BELOW: O ( - <br /> /�OIn� U �� GDNW77cgs / lJ CLIP-21-/Oe z N <br /> W <br /> Fee Rec•:12, <br /> N Check#: ?Off' <br /> Date of staff site visit: 6 ���`O Initials of site visit staff: VA <br /> y a---.- t <br /> C <br /> z� �APPROVED BY LAND SERVICES OFFICIAL: DATE: 0-S/Zoa <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF p n 0 <br /> C <br /> MI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 9 CD <br /> No <br /> . 0c _` 2 <br /> 'C -,.< O �l <br /> Transcendent: - Page 1 of 4 m g <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 _ <br /> NI <br /> rn ({ j <br /> C7 <br /> -1 <br /> ro <br />