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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o• y N <br /> CI. <br /> ' <br /> Permit Types (Please,check ap <br /> propriate and Fees: boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " ^� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 s O <br /> Accessory Structure(Garage,Shed,etc.) _$150 Addition/Alteration to Accessory Structure $150 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse $500 ° T <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 lv <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. w*Communication Towers&Signs require a different application form;see corresponding application,and fees. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r., g <br /> rI <br /> o <br /> Property Owner's Name: ���LCh 0 c 1 -1- 3 O r> \//C1 f 7-.4 n 1 ° <br /> Property Owner's Mailing Address: a'7(.145 S+af e load 35 GOebskcrr VL 5 4S9 <br /> City tate p C4 <br /> Property Site Address: I a t I 1 e r ness ► .v Par -1- 1 <br /> o <br /> Contact's Telephone Number: `7 15 -R(c(o - e a'7(o a <br /> Ny 7` <br /> Contact's Email: L,t)1'l e t e.ta i 1 lt.)1 lCi.t it tress @ ht -mai I . co m - - —4 N <br /> Legal Description of Property: I l C k Lt c'I k d o <br /> Section#: ?j c 3 Town#: 1 Lk) N Range#: f(o W Town of: (Da 1.I a.in(4 o <br /> q <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): 36 a? 3 <br /> :n <br /> Proposed Use of Structure/Addition: C.0.rn pc Y"p(,t.n d s-E-ru rr.f Li ire__ W x <br /> Anticipated Start Date: ►rn f>'lt?Lit CLfit', Home/Cahin;Commercial Business;Bedroom;Deck;etc.) \ V p <br /> Building Contractor: /U/A Sewer Installer: y -] <br /> — <br /> AREA BELOW minx LINE FOR.LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -O rT <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �,� <V <br /> C'fo//o to all cn ct c�t i4o NS -mow. CUP--zI-IO. z -..0 <br /> x <br /> s <br /> M Fee Rec:1Z,50O <br /> t7 Check#: ?/9S' <br /> 1 14 Date of staff site visit: 6�'1l9 r(.2 oat) Initials o site vis' `ti 0 <br /> z J <br /> I <br /> N �J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: -Y8/7"e2 241rr, <br /> x w <br /> Q <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF > W n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = 0 <br /> N _ <br /> CD C <br /> -'-0 7 <br /> Transcendent: - Page 1 of 4 v <br /> r, @ v <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 < a - <br /> Vyy <br /> a <br />