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LAND USE PERMIT APPLICATION - Burnett County, WI E <br /> Applicant Complete All Sections Below This Line 0 W <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) ° po <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 N <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 o IIf`` Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r.. <br /> ' Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> o <br /> o • <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: M l C.h 0 e.I ± Jean \ia ( +Z i 11 o <br /> Property Owner's Mailing Address: a`7 casS to+ f ,o ad 35 �,(�e.bs-kir W Z 5 4097-g" <br /> ()ph <br /> '' A\ fi'Gt ' . \ w 1'2 City .'• �n„ <br /> Property Site Address: W h 11--e I i W 1 Id it neV Par c) <br /> o <br /> Contact's Telephone Number: `7 15 -P(c(n - S a 7(c' c <br /> rn iContact's Email: �h i 21-C1 i I U�I IC�� 17e55 h6r C� . COC O t 11 <br /> `/ <br /> Legal Description of Property: 1 fl C.1IA Cit.'Ci N <br /> 0. <br /> Section#: Town#: 1 I-io N Range#: I(. W Town of: (<A K l a n c( o <br /> ?) N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): — u /j 3 GZ/3 v) 1 <br /> '3 <br /> Proposed Use of Structure/Addition: C_o,rn p Cj 1f`D LC Yl a Si-rt.) r±l.)re., W � x <br /> Anticipated Start Date: It't r leat(. 1-Ps ` Horne/Capin;Commercial Business;Bedroom;Deck;etc.) N N p <br /> Building Contractor: i\j/A Sewer Installer: -- `3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (V <br /> 06/44) q7/ crstoi4e;.f mow► Cli -ZI-(0. z <br /> • <br /> p.A-//owe 4 k&e. A Ad' /�5 e�2. GHQ,/ /f' %S r vice/ • <br /> or ref aces 144u$,- ten mee7L S/ze_. l i'7/- , <br /> H Fee Rec: f'2/.�O <br /> y Check#: $/9� <br /> f ^� - <br /> Date of staff site visit — � ( — a Initials of site visit staff: J� <br /> 7 -------) <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: YZO-e0c1 sM <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ^' <br /> i <br /> =3 <br /> 1 <br /> ..< I c:4 <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 1;- , , <br /> H <br /> Y <br /> N <br /> b <br />