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LAND USE PERMIT APPLICATION — Burnett County, WI a- r <br /> a a <br /> < "b <br /> Applicant Complete All Sections Below This Line a r <br /> a �� <br /> Permit Types and Fees:(Please,check appropriate boxes) g' 1 Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '' "k <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 c <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C)Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o j, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r— (u <br /> Filling/Grading $150 Boathouse $500 -C., <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> os II, <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. El' <br /> 1 <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. r <br /> - <br /> z n <br /> Property Owner's Name: N\IC h 0 t✓1 "I" .J£are \A/C I -I-Z-1 n o <br /> ~n <br /> o L <br /> Property Owner's Mailing Address: c r]a as stcut- ' o Qd 35 eb5-ter 409 <br /> '' ,, 11 City State Zip a <br /> W <br /> Property Site Address: h 1`eta t I Lt)1 IC e ( ti ess R L1 Va r -1-- <br /> Contact's Telephone Number: '7 15 -S'(e(n • S d 740 2 A E. <br /> Contact's Email: (),.)Yl I t e-t"C k.t I I IC'I t it ne55 t&I'tOfi n'1 CU I . Co r11 �' �" <br /> Legal Description of Property: 1 El C\Lt CI'C CI N 00 <br /> Section#: : c Town#: 1 Wo N Range#: ((p W Town of: O1K I t.n G( o ^� <br /> u. `" <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): 1-C }-- 36Z Q3 <br /> Proposed Use of Structure/Addition: C.0.rn D R ' o Li r G( St-rt.) (`-/-0 ire_ f <br /> W x <br /> Anticipated Start Date: III)Cfled.I ec-1--. ' Home/Capin;Commercial Business;Bedroom;Deck;etc.) ^1 . p <br /> Building Contractor: iv 11-\ Sewer Installer: J I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d (� <br /> 05l�or,� c // cortdil4evis �' C UP- ZI - lD, z A N <br /> g 1a-/5 7�tW - IAHl'7/ tY- 1S i ai r / \l�-llo�� �vew <br /> O e (a LC-i i I- - i'>L ( vt ell 1M e_e'71-- .S/ZE. i'I Mt n r T3, <br /> - Fee Rec: 121 5-1:'° <br /> Check#: W 1 9 k <br /> rri <br /> Date of staff site visit: 6 i`O - ©D 0 Initia f s' visit staff: ,b\--- rAY---- t-, o t i <br /> C7 <br /> APPROVED BY LAND SERVICES OFFICIAL: _DATE: 3/'Z$-ZO 2-L 7L s h�i <br /> a U O LI <br /> co x <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> Fill <br /> I tz: <br /> Transcendent: - Page 1 of 4 m <br /> Ri <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> Y <br /> L _J,) <br /> r <br /> v <br />