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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line <br /> a -- <br /> Permit Types and Fees:(Please,check appropriate boxes) :IF '6^ <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 N. O <br /> I <br /> / <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150. Deck/Stairs/Patio/Retaining Wall/Sidewalk — Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> 1 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. — <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-' <br /> ., <br /> / I o rb <br /> Property Owner's Name: M I C h� e 1 "l" -J-can WQ. l -I"Z l n ci -n <br /> Property Owner's Mailing Address: a'7 a a5 J tc 1-e_ Rio ad 35 Webs-icy- L 5 4 % t a <br /> , 11 n <br /> Property Site Address: (.,v�1 I+t, to I I Lt 1 OE it n ess ► V P City ar <br /> y <br /> Contact's Telephone Number: `7 15 -R l 1c' - 6 a 7(., t a <br /> d k i <br /> Contact's Email: t f e tCt I i l_A-)1 (Ci t c !less (&h ofi ()lag I . CO►"1m " w <br /> I <br /> Legal Description of Property: 111 C 1 Lt d t'Ci o 00 <br /> Section#:_.2j:7\ Town#: 1 L40 N Range it: ((p W Town of: Cr._K I a n d o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attachtt tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): l0� Z/ta 3 V <br /> c; o y <br /> Proposed Use of Structure/Addition: e.p..rn 1 1r0 Lt rl CI � "rL I (` U✓� 1 W F x <br /> Anticipated Start Date: Ir't)r71f'L{I ate, Homy/Capin;Commercial Business;Bedroom;Deck;etc.) r p <br /> Building Contractor: /V/c Sewer Installer: _ _, O A, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O V6\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z N <br /> D to/lt 4// rzo/tq '.7s � c /P- u-id. 7 s w <br /> is s,' -- nos be_ ,M©o / /Oy /%/�oz-%` 6H y C <br /> —Me_ /7ef 1i /n7I7 ce1M�1/4`1ce_. bOr/vl S,Ce. /tini7 5. <br /> Fee Rec:e/$ 0 <br /> N Check#: Rig$' <br /> � Z <br /> Date of staff site visit: I� '�oZ�� Initials of site visit staff: r <br /> 6 "— <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ISWZ41 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF W x <br /> 1.5 -< <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT p ,,, <br /> Transcendent: - Page 1 of 4 xa'< <br /> I k:: <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 1 111 <br /> 11 <br /> ro <br />