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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> �, r <br /> orl <br /> Applicant Complete All Sections Below This Line 3 �,N s. <br /> , NC <br /> _a <br /> Permit Types and Fees:(Please,check appropriate boxes) C <br /> p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 — k- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �` C <br /> Accessory Structure(Garage,Shed,etc.) $150 •Addition/Alteration to Accessory Structure $150 tv. <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> / Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i=. (. <br /> Filling/Grading $150 Boathouse $500 0 hp <br /> NP <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 d <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I... <br /> • <br /> Property Owner's Name: M[CIA e.I `4" •J Yl \ila ( +Z 1 n m <br /> o <br /> Property Owner's Mailing Address: a'7( J tC e. -1-210 ad 35 Webs-ter V' L 5 14 613 <br /> ', ', 11 City - • = �„ <br /> Property Site Address: W I �'Gt i I 1 CII n eSS R J Pa r K LA _t <br /> E T <br /> Contact's Telephone Number: 17 15 -S(c(c, - 6 cll'7‘.,, a <br /> o <br /> Contact's Email: t_,)h 1 t e tCl u I t i [cif( ( eS n <br /> 5 ',hot (Yl cu1 I . Co rr <br /> r Legal Description of Property: I ri C 1l t d r'CiqoSection#: 3 c). Town#: 1 1- 0 N Range#: f(p W Town of: O .( K I Q n c( o ram) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 4 -/ 3 6 Z/ 3 <br /> o <br /> Proposed Use of Structure/Addition: CL1 Tl Y_v(A. Y1 1 (` (J net 1 ✓� t w x <br /> Anticipated Start Date: 101 rn Gd1 c -e, Hone/Cahin;Commercial Business;Bedroom;Deck;etc.) ^, ° e" <br /> Building Contractor: /\//A Sewer Installer: \\1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> //er,) a coh�zioifs >M CCfa P- Z/- /0. z A <br /> a // x w <br /> z illis 5// ylee-45 74 be e,a4' �&/ 6 O/Zez iv d ii14 <br /> SN <br /> k f/e,y4 5 /n7`D f/1aACC_ LAD I� t S/Ze_ I/IM,74$, <br /> H Fee Rec: )Z,,57)O <br /> Check#: S/92' <br /> y� `am- M o <br /> Date of staff site visit: '� fL '1 0 Initials of site visit staff: 1. l K.-- rn <br /> 7, ) L ) J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/�/Zo 27/ <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' $W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o0 . ' <br /> at <br /> Transcendent: - Page 1 of 4 m m <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 - <br /> m LL JJ <br /> N <br /> H <br /> Y <br /> 6 <br /> ro <br />