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LAND USE PERMIT APPLICATION — Burnett County, WI - - <br /> m. <br /> b <br /> Applicant Complete All Sections Below This Line o y SJ <br /> 0 —c <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 &J <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 - <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> r Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse <br /> $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 iv <br /> 0 <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 /> ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> 9 <br /> Property Owner's Name: M I � '1- 7S-t' }e�� \ �� Z! zo <br /> � o -\ I <br /> o <br /> Property Owner's Mailing Address: f"]c as 5 tctj e i l c ad 355 (.1)e,b5-✓ 409j� <br /> , City State Zip n <br /> Property Site Address: `-)Iff_ta �,II 01 Id V' n es.S Y2V Par -t-+ K \W'' A\ <br /> C <br /> Contact's Telephone Number: (7 15 -F(,(c, - 8 a'7c, . a <br /> o <br /> Contact's Email: Lam)h I t€tn.i I W 1 ICI f I ne55 .001-nrICki I . CO►'Y1 <br /> Legal Description of Property: I tl C 1 Lt Cl t'CI o <br /> 0 <br /> • <br /> Section#: 3 c9, Town#: 1 1-40 N Range#: ((p W Town of: c.;ta.K in.r1 C'( v N <br /> 7 <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 2) - 3 6 2-9 3 <br /> Proposed Use of Structure/Addition: r✓=.Ct n P\q CO Lt Pl Ca' S{-Y L1 (` -I-v V e_ W o x <br /> Anticipated Start Date:_)t P (flCJ(cure, Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1\\3 �1 z Cj <br /> BuildingContractor: H/�/�!-1 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6\ <br /> 0Fob%LA) ci// cryH44otis -eyviA... CUP- ZJ-/oe z N <br /> Z a s s /Ye. ,i eeols , lie- wto c4 k e" 47 /0/1/2c ' 7/0 b n� W <br /> tole- i/ S 1Nr e-01MP(IQKC_e_ tAD(WI size /,inn, 7-5,, <br /> H Fee Rec: IZ2110 <br /> 6'..- <br /> f ( Check#: �f19R'`�O L-r,�}�;` I-Date of staff site visit: ���7 Initials of site visit staff: MY— r <br /> 7. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: -/Z9/ZoZrr, 6 ��pp <br /> o. u u u <br /> UPON APPROVAL: APP LCANT MUST POST COPY OF 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o N <br /> 1 Transcendent: - Page 1 of 4 m <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 rn <br /> rn <br /> -1 <br /> L- -J <br /> r <br /> b <br />