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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> n. <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure !$3 <br /> Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 kn <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> ,Driveways/&Campground Structures WI State Statute 59.692(iv)Structures $350 �- <br /> Filling/Grading Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) Isloo <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. (D <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:per olds,landscaping,etc. C- <br /> o <br /> Property Owner's Name: e yei <br /> f �1 n 5.5c <br /> Property Owner's Mailing Address I�� a (�� Q r� f� 13 <br /> —1 `-� Ci State Zip <br /> Property Site Address: —I d�4.0 �_ \����/��} � 1�//ate '�O/al� � f1_hUrv/ Wi ✓1fgl,30 � <br /> Contact's Telephone Number: Cp�� 'o�t0' ✓��f /fir � � ��" ^ �� o <br /> `'r c-• p <br /> Contact's Email: p< 1 K d a cL CC rl� <br /> 'f� i <br /> Legal Description of Property: T oY,;-,A 1)n s F8 n eC 17 0 <br /> Section#: Town#:'f'4 0 N Range#:R kU W Town of: C C�-K l eL.l d rjQ <br /> � o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> �L Tax ID#(I-5 digit number;found on tax statement): <br /> 1 <br /> 0 Proposed Use of Structure/Addition: ��-tX-tX�,��, �hed <br /> ,,Anticipated Start Date:OLD <br /> (Home//Cabin:Commercial Business:Bedroom;Deck:etc.) o O <br /> Buiidi gCo�act� ��� �� °� (�17� Sewer Installer: t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 9 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> 6 � z <br /> -� �74 ,/Uo us° 1wrG Q � <br /> s -o <br /> Fee Rec: <br /> y Check#:� <br /> Date of staff site visit: 2 11) LZ02,�— Initials of site visit staff- to <br /> - <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Y"7/"'-' 7 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF p D <br /> 0 a C <br /> 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT E � Cry <br /> Transcendent: - Page 1 of 4 Q <br /> 3 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 zrr (Ul <br /> o <br /> a <br /> 3 <br /> o <br />