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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line . 0' - <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) E �Q <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 21.13 <br /> tk.) <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 -go, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> 7, Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> o k <br /> Filling/Grading $150 Boathouse $500 b <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn d ,� <br /> S 1 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t-. gn <br /> o <br /> Property Owner's Name: M I C h 0 e I * -1 CL n \ila ( +Z I n ci ,, lit <br /> o <br /> Property Owner's Mailing Address: ri c b S ta+e_ f�l0 ad 35 e b5-tc r V I. 5(4-093i <br /> City ate <br /> cA <br /> Property Site Address: l�h I t-_ta I I 1,l)1 id e r n ess ►2.V Par fi- o <br /> Contact's Telephone Number: 17 15 -?(c(P S a'740 a <br /> Contact's Email: t.,jh ) <br /> I t etCl1 I u 1 idlt( Ylcss h6fi rYlCli I • Co►'r\ <br /> Legal Description of Property: 1 rl C Lt Cl t'd Ni w <br /> 0 <br /> Section#: ?- ,-9, Town#: 1 4c N Range#: J(o W Town of: C)rt K I(a h cy . N <br /> 9 <br /> *Attach additional page if needed Ibr lengthy description OR attach a copy of <br /> of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): " c��� .5 ' 3 6 z 1ta <br /> Proposed Use of Structure/Addition: r_t_Yll r R(D Le n C+! S{"Y'(.:l (`-`o✓e_ E H <br /> Anticipated Start Date: 10)(1-led(C(fiP. `1'Honme/Capin;;Commercial Business;Bedroom;Deck;etc.) n, = p <br /> Building Contractor: /\J/A Sewer Installer: I�► N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY A NJ <br /> NJTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �0 <br /> D f//o 2 ci// Gonc 4o#$ -mow► c0,-211 w <br /> 8 1 5 5 r'ie_. `t•eez/s -710 b _. m o -f" 60 6y /°%IzeaV ICE <br /> 4o ,6N -Hie_ 17-2.Nis (h-10 Ce1MPltcxNewe-- /A9, A <br /> t <br /> f t,e_ / l 1M►'71. , H Fee Rec: IZ $ 'O <br /> N Check#:3 <br /> t1� c <br /> Date of staff site visit: � ���' 0 Ini �—Is of site visit staff: 1\(--- r l <br /> z —°�—=—f <br /> as <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 00121V rep <br /> In co f 0 <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF <br /> r <br /> N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: Page 1 of 4 3 <br /> 01) <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 7 L..L JJ <br /> .11 <br /> -1 <br /> Y <br /> I <br /> ro <br />