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LAND USE PERMIT APPLICATION - Burnett County, WI a 2 ro <br /> Applicant Complete All Sections Below This Line 5• N <br /> F � <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 - 10.\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4' �O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 7, Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> Filling/Grading $150 Boathouse $500 ` <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> —- r\ <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> � r ° P. <br /> Property Owner's Name: M IC h 0 e � `4- -J tan \,JV Q. I +.7-1 (rl e/ o % <br /> Property Owner's Mailing Address: c:,7 c as st(,l±c PCad 35 WE'-.b3iC-ir V/ Z 5 40p-3i1 <br /> f . \ Cit tate _ F. <br /> Property Site Address: LC i--)i t-C-ta t I W 1 Id c ►r' i�)ess teLt va r 1�-o-t" - 3 A ` <br /> GeContact's Telephone Number: `7 15 -F (cco - ea- � 3-� a <br /> Contact's Email: (_.k.) )t t C-I C&i ) l�I [Cd t 4r( t e55 00-Mai I . CO►'l'l U, <br /> Legal Description of Property: 1 rl C 1 t,t Cl t'ci o no <br /> 0 <br /> Section#:3 9 Town#: 1 1-4() N Range#: f(.( W Town of: On_K I a ii r? o N <br /> *Attach additional page if needed fbr lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> M. <br /> Tax ID#(1-5 digit number; found on tax statement): 10/ 3 w 29 3 <br /> Proposed Use of Structure/Addition: r .arn.p ck f O i. Yid Sly() r f L)re_. W E j <br /> Anticipated Start Date:-)r'I(r e(1t a t-e Honte/Capin;Commercial Business;Bedroom;Deck;etc.) V " -6 <br /> Building Contractor: /V//A Sewer Installer: <br /> AREA BELOW Tins LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 069/6w a// Cootc/-4)%04$ 6roSAn atif - 2.1- /O, z W <br /> S\ <br /> H Fee Rec: )215-DO <br /> Check#: $I qg' <br /> p o <br /> Date of staff site visit: —I` _b r2 a''' 'Z Initials of site visit st ff: t- vAK <br /> 7 <br /> C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z��z0 2_� j U <br /> UPON APPROVAL: APPL .CANT_ MUST POST COPY OF n <br /> SIGNED�D P R�VI� IT APPLICATION IN PLAIN SIGHT <br /> 10 o rya <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <3 <br /> C2 <br /> n= M <br /> Or• a_ <br /> i L J <br />