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LAND USE PERMIT APPLICATION — Burnett County, WI CA <br /> Applicant Complete All Sections Below This Line 5' t <br /> a. ' <br /> y - -- <br /> Permit Types and Fees:(Please,check appropriate boxes) A4 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "W"\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 2 <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 n <br /> / Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C-. <br /> ' Filling/Grading $150 Boathouse $500 ° • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <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., '.o r. <br /> z <br /> l n <br /> Property Owner's Name: v\((_`h C e. -4--- .J^t tan \/VQ i +7-I.n ci -„ o Oh <br /> Property Owner's Mailing Address: c:`-7 c 5 S to+e- I-3o ad 35 (,t)e bsici' V' L 5 t--1-0y-3413- <br /> ' , City State <br /> Property Site Address: W``h I f-c to t I (.01 Id e Ir ()ess RV Par 't" I ' 1 <br /> Contact's Telephone Number: `7 i 5 -F., (C' .c' - ea'7So ' g 1 1 <br /> o <br /> Contact's Email: t_l)h I t e ta t / l.A.)I ICIf it ne55 I .h CCt I • Co ►Y1 <br /> Legal Description of Property: I r-1 C 1l t Ci t'CI N w <br /> Section#: „?j c Town#: 1 W0 N Range#: RD W Town of: C)n.K I Q n(i o 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): _ 3�z/ 3 cn <br /> Proposed Use of Structure/Addition: C.Cxn J C (0 LL Y)d [ Y-L1 C f 0 re__ . W F °' <br /> Anticipated Start Date: It 1l(11 ed t c 1-e Home/Cabin;;Connnercial Business;Bedroom;Deck;etc.) (1 N ° p <br /> Building Contractor: A/!A Sewer Installer: — I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY So A W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Z ZN <br /> 0�'o oW Qil cmnc44i,/1s w� G �-Zt-/O, z A <br /> nv. <br /> --I Fee Rec:/Z,J1'O <br /> Check#:j 8/9 <br /> C <br /> Date of staff site visit: 6'^ 16--pc?0 Initials of site visit staff: y <br /> z <br /> C �----q <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 3/Z02OZ - r t'----. �J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0W x <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT • Fi. <br /> c_ N <br /> . o <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 .ro <br /> ro <br />