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LAND USE PERMIT APPLICATION — Burnett County, WI 2. t~ <br /> a .0 <br /> Applicant Complete All Sections Below This Line 5 , <br /> a. <br /> 4 d <br /> Permit Types and Fees:(Please,check appropriate boxes) W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 OD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� \, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o lb <br /> / \. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r=. ---, <br /> Filling/Grading $150 Boathouse $500 o N <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 :./' ib <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1% <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r ,, <br /> 0 <br /> Property Owner's Name: M I e Ir)(1t I `'r .J-e(i_n \ila 14-Z I n ci m <br /> Property Owner's Mailing Address: a 17 cc a5 ta-t-e- Rio ad 35 U.)e_bsicr VV' Z 5.40V-5-69" <br /> rTh City a e E. <br /> Property Site Address: LA.-)h I to to t 1 LO 1 de I`1 e55 ►`RU Par -i--- • '' <br /> ( <br /> Contact's Telephone Number: ` 15 -R(,(.o - 6 a e7So \ g .---.. <br /> Contact's Email: (...L)1")I t€ tA.1 / k-1-)I ICd t d- r)e55 @.hO CU I • Co m <br /> Legal Description of Property: 1 CI C\t t d t'CI N 0 <br /> 0 00 1111P. <br /> Section#: 3(9\ Town#: 1 HO N Range#: ((a W Town of: O T K I an(,'( <br /> 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): ti -3 6 07,3 <br /> o m <br /> Proposed Use of Structure/Addition: C..0.C1 Y'p Lt Yl d sly() (` (�ire, ‘Ax <br /> Anticipated Start Date: )01('ll PCB.t et 1-P Home/Cahin;Commercial Business;Bedroom;Deck;etc.) 1 N p <br /> Building Contractor: /\//I\ Sewer Installer: N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: NJ <br /> r //�� v� _ , <br /> f I/O ti G I/ G0I1t j�-lOr1 S T� C U f-'?/ /D z A s <br /> Ool, W <br /> G\ <br /> Fee Rec: /2, 7 <br /> N Check#:e/V. <br /> AIDate of staff site visit:6'—I� � 0 Initials of site visit staff: �� y <br /> C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:3/206 < r <br /> v Ng <br /> UPON APPROVAL: AP ICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 7 ao N <br /> -C N d <br /> O <br /> Transcendent: Page 1 of 4 m �— <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 r1 M <br /> d `• <br /> cn <br />