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LAND USE PERMIT APPLICATION - Burnett County, WI � r <br /> a g <br /> Applicant Complete All Sections Below This Line 4 <br /> FO <br /> a _ <br /> Permit Types and Fees:(Please,check appropriate boxes) LT, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a XI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �? <br /> min <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> 7 Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c-' (Z <br /> Filling/Grading $150 Boathouse $500r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 v' <br /> = 1 <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. -o <br /> CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ,-- g . <br /> Property Owner's Name: M I C.h 0 e i `4-' —Stan U,I a. I +�I n rt <br /> 1 -n <br /> Property Owner's Mailing Address: ar7 t1 c 5 S ta+e o ad 35 We bsic v VI 5 40v-34- <br /> \ City , = n <br /> W Property Site Address: h I i-e to I I WI Id E r ess 12.v Par K 4-fi-- 3g E <br /> Contact's Telephone Number: `7 15 -g(G..o - s d r7so <br /> 0 4 <br /> Contact's Email: Loh' fe1`al I u.)I IC'I t'--►r/7e5S @hct- rncu I . Com <br /> Legal Description of Property: I rl C.\t t CI e CI o w <br /> Section#: :2)(9., Town#: 1 L O N Range#: ((a W Town of: C(.LK ill n r f 5' - � <br /> *Attach additional page if needed fbr 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): n _ 6Z9,3 <br /> '4 --1 H <br /> Proposed Use of Structure/Addition: C.0 Xc 1 R V-C Lt. n d (` I U sly LI ✓e W x <br /> Anticipated Start Date: 101me t CLl'e Home/Cabin;Commercial Business;Bedroom;Deck;etc.) p <br /> Building Contractor: Ai//1 Sewer Installer: — \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �\ <br /> D f/4to Q// CeV11 4%Ids -7M CUP- zi-/ z s. <br /> x <br /> 0 A/s die_ p S 4 be- me 44 ed b y /o//zo zfL 42 dr►_H% W <br /> �" �aH�- �/Y 5iZ� Y` ev' cwP=ZI-1O. <br /> �� ��S in 7�U/ cow, / / / li _/� � � <br /> 0 TAeA c'7% /7 5 Q//O e� 7b y�w14/1,1 tIA04./ /�'IS fJal►^ed <br /> L .., Fee Rec:/2/3� <br /> DV' {pep/ c I� Gt S 7 /lil ei� I'1/)e��" li/Ze h IAA/ N Check#: gt'?g <br /> r I y �"1 C <br /> Date of staff site visit: �t b © Initials of site visit staff: b L- y , <br /> APPROVED BY LAND SERVICES OFFICIAL: /u�'' DATE: 7/007�z7r11 ° EM <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <5 0? <br /> T N - Y Y <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o ^, o <br /> Transcendent: - Page 1 of 4 m m <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> m �� J <br /> O <br /> v) <br /> H <br /> 'b <br />