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LAND USE PERMIT APPLICATION - Burnett County, WI - g <br /> Applicant Complete All Sections Below This Line <br /> rD <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> r: <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> f <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n ID <br /> . Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> / 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 i eb <br /> R. ft <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ET <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. t . <br /> 0 <br /> Property Owner's Name: M I C.17)0 e I mi(- Sea r) W a (_ +.Z-I r1 o <br /> 5 <br /> ° <br /> Property Owner's Mailing Address: a'7 f)ab J ta. -e_ tri o acl 35 We as-tcf W L 5 409 o <br /> City a e 1'. = n <br /> Property Site Address: 11 1 t a i I i d e Ir n e5s 1�U ear K (._ -. 5g 4 II <br /> Contact's Telephone Number: 1-1 15 -p tap .- e>a r7so ° `° <br /> No <br /> Contact's Email: (_,t)h i t etCt.i i uO i ld-c Ir he55 @J ho- f"1CU I . CO►Y-\ �' <br /> Legal Description of Property: I r-t C\i.t d t'CI N o0 <br /> Section#: :2j c Town#: 1 L O N Range#: 1(p W Town of: OrIK)a h 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): 3 6 Z-/ 3 <br /> Proposed Use of Structure/Addition: (."Qrn p R(O LL)')GI 5 r1. ' -1"o✓e. W f k <br /> Anticipated Start Date: lM fll ed t C 1--e, '?Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - <br /> Building Contractor: A/�A Sewer Installer: -3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V 'ZsN <br /> 0 f;/i//Lo Cf/ G(7Nsr: +7Id"is IAA Cud'- Z1 -/0. z <br /> CD i u' s r - vt-eecis 4 e_ oc:4 i4c(/ fl y /o//zoz S' A <br /> H c�� lie'm � 14.04sIt. /1 ) 7 b� <br /> cf 5 'AAe-+��o►t ea/ /Pt cL P- 2_/-/©o ` / <br /> 3 -rho ei C e.V' I s Q/�o w p� TD U e-W\a h 1' LA,St:I 1 /S Y'�p ct)rt[Y OY - Fee Rec: /Z, `D <br /> / t e �►��"� �7�'S Check#: 2/99 <br /> I'��e� k s/f 'fG►e..� tAA S d <br /> / <br /> Date of staff site visit: ' 7' - a-E) Initials of site visit staff: �I, M <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3//-7/AZT = - <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W C <br /> SIGNED PERMIT APPLICATIO <br /> N IN PLAIN SIGHT <br /> o N E=31: <br /> Transcendent: - Page 1 of 4 <br /> N <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 1 m <br /> rri <br /> 0 <br /> v <br /> Y <br /> 4 <br /> ro <br />