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LAND USE PERMIT APPLICATION - Burnett County, WI 0. <br /> .- b <br /> Applicant Complete All Sections Below This Line 5• - It <br /> a <br /> 4, <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0) <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 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> X Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r <br /> ' Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w i <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. i-. <br /> Property Owner's Name: N(C 110 t✓I -"f" -lea \Na. I +Z I n <br /> Property Owner's Mailing Address: a ri fT J t(�-}-e- Ko ad 35 We b5-cr� A cJ L Ogg-° . I <br /> '' .. `` City toe E. �„ <br /> Property Site Address: W h I t-eta I I W 1 Id e r n e5S RLt var Lot.. J f7 K <br /> Contact's Telephone Number: 1715 to(,-, cal r7So g II <br /> a. <br /> d <br /> L <br /> Contact's Email: k)Y1I t eta i / Lot (Ci-e( hc5S i oofi rnCU 1 . Co/I'1 p <br /> Legal Description of Property: 1 rl C‘Lt CI r CAI o <br /> Section#: ?) Town#: 1 I- O N Range#: [(p O W Town of: K I an c( d <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): - Z-sy 3 <br /> C0.rn ro IA nCt c� o G <br /> Proposed Use of Structure/Addition: > Y l,1 (`f �� h W x <br /> Anticipated Start Date: l 0)f1leCi.i Ct-i-e -Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° 5 <br /> Building Contractor: /\//A Sewer Installer: a <br /> W <br /> sc <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z A <br /> e foliow Q// CnAl C4;ioa7S -& Cu p Zl--/D, x em W <br /> �>°� 4 ee./5 �v he- !'vied d i l4 / Z <br /> ZO ' 74 6 rD) Thr s 5 ' y // <br /> 6NH TNe- /fps /K74 GOr,y,dakf e. t- c'>% Size 4'►'7'-S. <br /> H Fee Rec: (2,,5b0- <br /> Check#: g/?p <br /> 6 i <br /> Date of staff site visit: � r 7 c90C:9-d Initials of site visit staff: 9 •\---1f\\ <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/7/ZOZ <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF Ica <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I a N Rr' <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 M. <br />