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' LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> a ' <br /> o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "� <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 rl <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 n <br /> }� n <br /> ADriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150_ Boathouse $500 `♦ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 m t <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. FS <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -o A.—. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t-. <br /> o <br /> Property Owner's Name: I v 1 i c_h o t I `'l" .J-cQ n W a I +Z I n rl rt <br /> W <br /> ' 11 0 <br /> Property Owner's Mailing Address: c)'7 c 3 J tat-e -Plc ad 35 e b5-/cr I 5409-a <br /> , , 11 t ` City State Zip <br /> W <br /> Property Site Address: h I f a I I Li 1 id e i eSS i..L var a-t-µ c- ,� <br /> Contact's Telephone Number: `-7 15 -S'c,,c, - 8 3'710 o <br /> t\` a <br /> Contact's Email: i_Chl i t el-ck t / u_.)1 [Cif I r)e55 001-MaiI . Corm `O <br /> Legal Description of Property: 1 tl C\Lt C t'CI o w <br /> Section#: 3 c Town#: 1 40 N Range#: I W Town of: c�,I_K 1( .n Ct o N <br /> *Attach additional page if needed Or 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): >/ g-- .� 3 6Z-?3 <br /> CO Proposed Use of Structure/Addition: C0.rn CD Lt. Yl 5{`rU (� U hi° , £ k <br /> Anticipated Start Date: ICI)(1"1 Nei I co-1', Home/Cahin;Commercial Business;Bedroom;Deck;etc.) V <br /> N p <br /> Building Contractor: /V'/A Sewer Installer: — t <br /> 4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0f/lw 4// caya (oi►s &IAA cUP- 2_1-/O. z <br /> -8►►s stye. 4eeds Le- r-lecZ ea/ 6y /0/// � 4 i11�, W <br /> z <br /> je. /'/ems /NTD c.oLA f/r 0 klc—_ L,)Mu . S/2.e._ AL,,> . <br /> H Fee Rec: /2-990 <br /> N Check#: 3Y98- <br /> r `� C <br /> Date of staff site visit: 1`.1 �c�`as h lniti Is of site visit staff: ��^ ( .{ r. <br /> rrl <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: S/L7 ZOZ� rn< Iv <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y m a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o y 0 Giii <br /> N o <br /> Transcendent: Page 1 of 4 r"„ w / r::: <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020Iiiill <br /> C�J <br /> ro <br />