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LAND USE PERMIT APPLICATION — Burnett County, WI ro <br /> Applicant Complete All Sections Below This Line a• y 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) OQ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �‘11 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 c\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n P 16 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 <br /> e Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading ,$150 Boathouse $500 ° 10 <br /> Six Month Camping Unit(One Per Year) $100 _ Permit Extension(1 Year Extension-Allowed Once) $100 G N <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. -o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> Property Owner's Name: N\1 C LLci e I '^1-" -Sea im \A/C. ( +Z i n ,n <br /> I o 1 <br /> Property Owner's Mailing Address: c '1(- tn.+('_ Pload 35 webs-icy- VI_ 5 L 93. - <br /> City <br /> Property Site Address: LA)�1 I I- _i-a t i Lt.) i <br /> t d e I (')eSS RV 1---Gt.r Lc,-1- M <br /> Contact's Telephone Number: `.1 j 5 f;(c(,, a 7‘e, /��1 /�/� <br /> fi �Y / 1 1 <br /> Contact's Email: �,L;4l i t e 1"L.�t ) I ICI t t 17eSS 110 rn Clt I . COLO/11 v `1 <br /> Legal Description of Property: I rl C\t,t d t'CI opq <br /> a <br /> Section#: ?j Town#: 1 1-40 N Range#: j(, W Town of: 0(a_K 1 a)1 (7i; N <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): 46.96/ — 3 G 2..9 3 <br /> v, <br /> Proposed Use of Structure/Addition: Co.xn.P C1 Y-O Li. f d 5frU C f Ore_ W <br /> Anticipated Start Date: It'1)(Tl ed.t CLfiP, "Home/Cahin;Commercial Business;Bedroom;Deck;etc.) \ r p <br /> Building Contractor: iv'/A Sewer Installer: — -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY . <br /> f� THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ef 'f/oLJ cii Co4cZ 4e'nS "ell,0..., CL'P- Z(- /O• z <br /> 0 TA ►ms $I - A te84 10 6e_ ko ccit=41 b y /O/1/zo2_51 iv 6r w <br /> WI e_ /4-M s ,',4 4 GO t nl'l t to 1C€ G,o/ it S/Le. /I'w,)'71/4e <br /> x Fee Rec: JZ/�O <br /> Check#: Fr IV <br /> Date of staff site visit: c�'—C6' Q2 eg_a laidof site visit staff: ' ' NC E- <br /> APPROVED BY LAND SERVICES OFFICIAL: `1✓�'` DATE: 3/7-S/ZD Z7 r <br /> n� <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF F(ca n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 _ G� <br /> '17S° S <br /> Transcendent: Page 1 of 4 7.,`c <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 ria111111 <br /> vri <br /> 4 <br />