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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line c <br /> F <br /> Permit Types and Fees:(Please,check appropriate boxes) o U h l <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4.'70 <br /> 6 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° � <br /> 7.. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 7 i <br /> 0 <br /> Filling/Grading $150 Boathouse $500 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 R <br /> m <br /> 0 <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. '..., <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I-- g <br /> z <br /> Property Owner's Name: M I C h 0 e,I -4- --)tQ n WQ ( -I-Z 1 n 1 F o <br /> o <br /> Property Owner's Mailing Address: ( '7 a 5 S tat trio ad 35 We_bs-fc r WI 5 L-Jg9)b <br /> I , ` City j _ tate zt EE <br /> Property Site Address: W h I f�to i 1 WI der ()e.ss RLt Par l-(0 t—1--4". 471 c' ik <br /> o <br /> Contact's Telephone Number: `7 I Si(ctc) d r"-1�' --� a. ,mot <br /> �Contact's Email: C h l f e tcl i I l�I tCi f it 17e.ss @,Viol-rn Ou I . Co m g. <br /> o <br /> Legal Description of Property: I 11 C.I t,t d r CI o o� <br /> Section#:_�j c . Town#: 1�O N Range#: J(p W Town of: On_K I a n s. <br /> o N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): _ • • <br /> 3�v 2 / 3 vv ` <br /> Proposed Use of Structure/Addition: (`ax-1- Y o L nd 5{rL.) (`f o►% W x <br /> Anticipated Start Date: )r�)i(nea(a fiP Home/Cabin;;Commercial Business;Bedroom;Deck;etc.) , (\, °v p <br /> Building Contractor: /V/A Sewer Installer: N -- 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY —k t. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 6 �o/loca 4// cePnc�i1/2'oiS -Ago j''I CUP—Z/—/O. z S N <br /> 0 / '/loweJ Tv kejef D' q7 /S 744 e4A€_ UPrha/ /Y—/$ YV/9Q/v c / VI <br /> OY re-p /aced, ltAu57 71-4en wle,€ / 5/Ze // /745. <br /> .. Fee Rec: /Z/.5-€7° <br /> Check#: $"9. <br /> Date of staff site visit: 6 -- (r 7--a Ol� b Initials of site visit staff: t-- r\ r <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> DATE: /2/?OZ� � J <br /> Fia <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF -,-- jM <br /> r -< <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Ocn <br /> P. ,; <br /> Transcendent: - Page 1 of 4I (:: <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 7� 1J1] <br /> ri <br /> c� <br /> �� ) <br /> Z <br /> ro <br />