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ID <br /> LAND USE PERMIT APPLICATION - Burnett County, WI CC] <br /> t~ <br /> Applicant Complete All Sections Below This Line a' <br /> Permit Types and Fees:(Please,check appropriate boxes) z 0 W <br /> pa <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " .0 <br /> 41 <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 g <br /> N. <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 R <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 R) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading ° ,g/ g $150 Boathouse $500 p <br /> Six Month Camping Unit(One Per Year) ( Once) m <br /> p' g $100 Permit Extension 1 Year Extension-Allowed $100 <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 /> CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. g <br /> 0 <br /> f ri <br /> Property Owner's Name: M ICI)Y 1 C CI `'l" J tan f\ \.A/Q I + l l Gt , • ) <br /> ' <br /> Property Owner's Mailing Address: a/7 a as S tat Ao ad 35 Gpcb5-ictr WI- 5 - 3-o°'9 . <br /> City a e <br /> Property Site Address: WhIf tat I WI ICIe r ties .0 Par (gyp-t-.* r ` <br /> o_ y <br /> Contact's Telephone Number: ``J 15 -c'(v(o - 8 a`7� Ge P a <br /> o <br /> Contact's Email: utJh t t el-al i l.,l)I ictt it nes5 hot()ICU I . CO r11 v ^ <br /> Legal Description of Property: In C It,t Ck k d N , <br /> 0 <br /> 7. <br /> Section#: ?)<-A Town#: 1 40 N Range#: ((p W Town of: D(tK 1 an c4 . <br /> o <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#(l-5 digit number; found on tax statement): 36 Z? 3 <br /> c <br /> Proposed Use of Structure/Addition: C CLc l ) (0 U.YIC� Sf rU t^-Ft)re W o 'H <br /> Anticipated Start Date: l[T nedt Ct ti', Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^, ° u <br /> Building Contractor: A.//A Sewer Installer: 1" <br /> AREA BELOW TillS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> /.o//ett) cell c.5,4�i;iottS sA CUP- z-(--/C , Z NI <br /> W <br /> x Fee Rec: l 2j S" <br /> r7 <br /> 1 0 <br /> Check#: B./9 ? <br /> ]� :L._ ( <br /> Date of staff site visit: V — v-ogo. Initials of site visit staff \ V m <br /> Jl J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/ /.02--9 "-1, <br /> a. <br /> 11t► i <br /> UPON APPROVAL: APP CANT MUST POST COPY OF `: Cln <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD o N <br /> Transcendent: ` e <br /> Page 1 of 4 '•3 c <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 . <br /> b <br />