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LAND USE PERMIT APPLICATION — Burnett County, WI a [ <br /> b <br /> Applicant Complete All Sections Below This Line 3 N t$ <br /> 0 "� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> ro <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 \ rD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> f Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> ' Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> o <br /> *NOTE:After-the-factpermits G(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 /> n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- J <br /> / o — <br /> Property Owner's Name: M LCJIIQ e " .i tan \!V a I +-7-1 n -, Ilk <br /> o <br /> Property Owner's Mailing Address: c_'~](- 4.5 S-fa e- 1-21 oo ad 35 We asic VI_ 5 t4 9 j-EL • <br /> \\ L' City a e 5. <br /> Property Site Address: I-0`�t ' <br /> t CI t I (,�J 1 ICi e I 0 e S R I�GI r K Lo--}"`'-'' /v '' Z <br /> Contact's Telephone Number: 15 (c(a 3'7c-- G� /V 0. I <br /> N o <br /> Contact's Email: t_,+ )hit"eta.t I u)I ICI C if r)eSS ).Viol-rncu I . Co m -0 M <br /> Legal Description of Property: 1 11 C I t t Cl c'C/ o <br /> Section#: 3 c Town#: 1 -4D N Range#: (Co W Town of: oak 1 a ii(4 a N <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q -.C. <br /> q. <br /> Tax ID#(1-5 digit number; found on tax statement): ,LtI 3 6 VI 3 <br /> Proposed Use of Structure/Addition: C...U..m P C. CO IA. t`)G( S f r L-1 Csf O re_ t 0 F G <br /> Anticipated Start Date:_)(1)aleCtt CL-t—e, Home/Cahin;Commercial Business;Bedroom;Deck;etc.) N ° p <br /> Building Contractor: j\I/A _ <br /> Sewer Installer: I �1 1 1 <br /> AREA BELOW TIIIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 'C A vim' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 't S\ <br /> (9F/t/w «// coko�i'-ps . - c-U P-Z(-fa, z No <br /> © p 'I H s i'Ze per Cu P-zI-'Oa �^' <br /> beck/yaw/0 �'b e uc� / <br /> 6) 0.0Ae V' i/--e �-w�5 q v g//ow e,o/ re."Nati, Uwk.l titt, are ref r•efel►'red <br /> � <br /> p r ref ICI C e // PA a 5- tt e--v1 tvi e e7L S 12N l 't,.�I I <br /> T�s <br /> H Fee Rec: 1Z,5V& <br /> Check#: 9/9$' <br /> S <br /> Date of staff site visit: 16 ��b�6 Initials of site visit staff: �I r <br /> APPROVED BY LAND SERVICES OFFICIAL: 2 emu- DATE: 3/Zg/�Z7` ..�=:= "' Eifi <br /> `—`� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '. a <br /> 3 o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a <br /> �a ti <br /> 0 <br /> a <br /> Transcendent: Page 1 of 4 r < <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 1 M <br /> Nc ) <br /> a, <br />