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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Z '3 b <br /> Applicant Complete All Sections Below This Line 5. N <br /> n <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 'kX1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 rp <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t- n <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r I <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a ' 4 <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 /> o <br /> Property Owner's Name: M t c.h 0 el `'1- ,,.} ct1'l \AA I f Z 1 {r1 c o <br /> �, „` . ( 5 <br /> _ ' 'l <br /> Property Owner's Mailing Address: c: ]Ci t e� a-{- F 2 1 C ad 35 W ebs i/ W L 5 Lf 9 I <br /> V City ate Zip ; <br /> Property Site Address: (�InI f-et a t I LiIJ 1 ICI e V- (i eSS U aCz r t--0-1". 2 i3 C <br /> o <br /> Contact's Telephone Number: `7 15 -r'&cc, - S a..7(c z O a, a <br /> D <br /> Contact's Email: (A)1.-1 I e1 L.� U i I l I Ed ►r I�eSS h��C�t CO►1'1 ' <br /> Legal Description of Property: I r.1 C 1 Lt Cl2'ci o w 41111. <br /> Section#: �j c9, Town#: 1 H0 N Range#: j b, W Town of: cm<1' h o <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 9.3 2 <br /> o <br /> w <br /> Proposed Use of Structure/Addition: G(�C Tl p Li_I�C� SIT'L-1 C f 0 re_ w x <br /> Anticipated Start Date: )Y )mYled.I C2-1 t' Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N a 5 <br /> Building Contractor: A//f1 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: t 6 <br /> 0 /low 4/l U,�t s�o,►s , c.ciP z/-/o, Z 1;) N <br /> c2 7-A,,, slit__ "it eo/ �o Le- Moc4Klea/ by 10/zozfi Art14y <br /> w <br /> Wile- 17-e.WI S I'm 71v GO IM U if akiGe— (,0/n'I S/z e f l iAA1 7-5. <br /> H Fee Rec: /43190 <br /> Check#: g196:1 <br /> Date of staff site visit:6 - 00• " Initials of site visit staff: bi—/IAK— i— <br /> zg <br /> r/ „, <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/Z27�a r c CO <br /> UPON APPROVAL: APP ' CANT MUST POST COPY OF W n 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - o o N <br /> CD c <br /> Transcendent: - Page 1 of 4 ' 3 W <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 = R1 <br />