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LAND USE PERMIT APPLICATION — Burnett County, WI a " r <br /> ,, <br /> -. b <br /> Applicant Complete All Sections Below This Line 1 c tit N <br /> a- 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) O FO kM <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> ( 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t=. ....I— o <br /> Filling/Grading $150 Boathouse $500 , <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 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 o-. 9 <br /> Property Owner's Name: MI Cl/0e,I '4- -J Ca_n \A/aI +ZIn ci m p <br /> rci-- <br /> Property Owner's Mailing Address: c '7t�a. S ta.±C -. o ad 35 Webs-Icy V►' Z 5 4'0-j'a°- 4 <br /> /I ,, City State ip E. <br /> Property Site Address: W\\ 1 A-a 1 i I der n ess ►QU Par -I- E <br /> o cContact's Telephone Number: 15 -S&(,? S a�� a <br /> v <br /> Contact's Email: SOY)I t eta i U.W 1 ICi e(neSS hot rnCIJ I . Co►'1'1 <br /> Legal Description of Property: I r1 C 1l.t Ck t'd N 00 <br /> a <br /> Section#:2) Town#: 1 40 N Range#: J(p W Town of: 0(1K I an c/ o <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): 36Z93 c„ <br /> Proposed Use of Structure/Addition: (lamp Y`-o a__Yid SfU r*ti✓,t'_ W k <br /> a- <br /> Anticipated Start Date: V 'imed1 cc-i-e �Honte/Cabin;Commercial Business;Bedroom;Deck;etc.) = <br /> Building Contractor: ,Ai/A Sewer Installer: -- " O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> / /er ,, ce// Coo ;00 &� CUP" Ei--/O, z s C• <br /> fa <br /> - Fee Rec: Z/S-129 <br /> y Check#: $/2.8' <br /> C <br /> Date of staff site visit: � 'k L ®'1'���© Initials of site visit staff: RY--- m <br /> J <br /> APPROVED BY LAND SERVICES OFFICIAL: ,1 DATE: 392-5Z c� nr <br /> m.._d�� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '- <R n 0 <br /> .00_ M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 0 ^� o <br /> Transcendent: - Page 1 of 4 a d <br /> LITIll <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> -I <br /> b <br />