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' • LAND USE PERMIT APPLICATION — Burnett County, WI a gb T, <br /> Applicant Complete All Sections Below This Line <br /> a , <br /> Permit Types and Fees:(Please,check appropriate boxes) V'\ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "w ',A <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 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 , 1 <br /> fDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' <br /> Filling/Grading $150 Boathouse $500 ft <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w ..., <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-� <br /> o - <br /> . rr - <br /> Property Owner's Name: M I C.1/)0 C :Yea can \Na l +Z 1 n <br /> ' ' I � <br /> Property Owner's Mailing Address: c�`7 c 3 J tcd-e- Pic acl 35 1Webs-ice \✓L 5 4-093a <br /> i P. n <br /> ', ', 11 E I 1 der 1i ess 1'.v Party _� <br /> Property Site Address: W ail � EMI <br /> 1111111.111111111 <br /> o , <br /> Contact's Telephone Number: `7 15 -p(4-:(c0 -- s a 7 ... <br /> q j, b� f \ �\ <br /> Contact's Email: 1,t)h I f ei&i I U )I ICI e( he55 Viol- MCU I . CO al w` -- `a,. <br /> Legal Description of Property: 1 r i C\i t d e Ci N 00 <br /> Section#: :'p c9\ Town#: 1 140 N Range#: J(c W Town of: a-1K I r .n c( 0 <br /> ro <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* R <br /> Tax ID#(1-5 digit number; found on tax statement): 9U / 3 6 Z/ 3 <br /> Proposed Use of Structure/Addition: C.0.rn.p R(0 Lt. Yl a S-r Li C'*t)re_ ' <br /> Anticipated Start Date:_),( )r11ea t Cc 1 ('. Honie/Capin;Commercial Business;Bedroom;Deck;etc.) ‘ N e <br /> Building Contractor: id/A Sewer Installer: — N --1 d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> O Facto ea coHcr �4 -yf - An cuP- 21-f&, z A W <br /> 74 <br /> 0 b b Q r a-i-i'o -b be- c-• --cd-e /h s/ze_ f t--r C l,t P-Z1-le), <br /> CDO-Hnee l S atve, cl//o e-d l revv,Q/k 0H747 7`-hey are., _/I <br /> ►r'e0ctly�p� od' " -/ /acea/ n41) 7� 1 eh Y14e�71- s/Ze— 1,rv�t�/S. 1z S 0 <br /> / - Fee Rec: r <br /> 7, Check#: g 19$- <br /> , 8 <br /> Date of staff site visit: %.; Initials of site visit staff: I /1‘.4 y " -� -- ] <br /> z. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: A-81/"?-4°2--T I <br /> a 4_r/ <br /> UPON APPROVAL: APPL -CANT MUST POST COPY OF co W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �o ^Transcendent: Page 1 of 4m <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> L J <br /> 6 <br /> b <br />