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LAND USE PERMIT APPLICATION - Burnett County, WI a- r <br /> a 3 <br /> Applicant Complete All Sections Below This Line a' <br /> el a ' <br /> Permit Types and Fees:(Please,check appropriate boxes) p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure <br /> -$300 Addition/Alteration to Commercial/Industrial Structure $200 <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 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- 1"---t <br /> Filling/Grading $150 Boathouse $500 - I, ` 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 . , <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. iic <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 /> Property Owner's Name: 1VW11 10t ( ''1 0._n V/V C1 I -1" —1 f1 C� m <br /> ProaProperty Owner's Mailing Address: ,. c t_ � ° <br /> p yL tat i 1 �o a d 35 ( ��bs rt� I. 5 ��, <br /> City o <br /> Property Site Address: 1.1-'1-II C CZ I I �aJ I ICI v' I)C,f.:-„S ►`'V 1-lGi r n <br /> • :F.Contact's Telephone Number: 15 - F.'" c c � : <br /> Contact's Email: i.,_ i i 1 1 c "I C , / t_t. ' 1 ICI C t f )c,=;S @ Viol-met( I . CD ii, , --P <br /> Legal Description of Property: I I 1 C 1 LC CI r CI N <br /> 0 <br /> Section#:�=', ..,_Town#: 1 t-1C�N Range#: f Cn W Town of: C)� K i rLt��� n a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tux system property page.* G. <br /> 6)9� - 36z9 • <br /> 3 F � ! <br /> �Tax ID#(1-5 digit number; found on tax statement): ` i <br /> Proposed Use of Structure/Addition: ((. ( n FD i-O y-C 1,t nct S-tyL) r 1-O i'� 1'� H H <br /> Anticipated Start Date: Ii't)i11r'(l.1('t -I-c, 'IHo,neiCuhin;Commercial Businevs;Bedroom;Deck;en.) <br /> V <br /> Building Contractor: ,\e /t Sewer Installer:= <br /> AREA BELOW Tills LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY '� rT' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q ( i N <br /> b >o// & Q// C_oke4;4bvrs mow. CUR-zt- (© . z s `s' <br /> 1) 7A/5 S(k Ae,e�5 yb 4€ o/�- 0/ by /a///zort ,d v,'Jr c�'w <br /> Tilt. /14...nn5 /K4 cmI.Np/)4Mce_ Lc7/WI 5/2.e // L' iAs, s <br /> ti Fee Rec:/Z1 SW <br /> Check#: g'i 9g <br /> Date of staff site visit4n----D-oa 0Initi Is of ' e visit staff: /tt"\ r <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 0/ZO <br /> r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . co a fill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -` <br /> n N <br /> cp Transcendent: - Page 1 of 4 , z a <br /> ' <br /> ,� 1 Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 <br />