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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This line <br />ICE <br />' Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300Addition/Alteration <br />to Dwelling/Principal Structure <br />$200 <br />Commercial /Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />XDeck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />WI State Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading $150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 <br />Permit Extension (1 Year Extension - Allowed Once) <br />I $100 <br />-NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />1* *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. <br />Property Owner's Name: i jum" 12c -t- -p*KzL14Ar nwd-1 Q �T <br />Property Owner's Mailing Address: q% &{1W (27yr-- rrft 6JDjk-- <br />City State Zip 6. <br />Property Site Address: L.Aciur-, Pid D7 - o3+ -2Z - 37 Ie " 2,t 5- 05--ov7"01f 0o0 <br />I <br />C'ontact's Telephone Number: (017. <br />I <br />ontact's Email:_ L.6MA <br />legal Description of Property: L -Or 4152!nA 1A4JC l Fgyt. C— 60/(+ _i o <br />Section #: Town #: N Range #: W Town of: _ <br />C <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):t{ <br />Proposed Use of Structure/Addition: Lei (tt}a,4& j <br />Anticipated Start Date:_ i0 (Home,Vabm. Commercial Business: Bedroom, Deck: etc.) <br />Building Contractor: K/{yqj44fKt �iL-IW1-I4Mb1rJSewer Installer: _ SWC, <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />sl oAA\,440 <br />n , <br />e <br />Date of staff site visit: Initials of ite visit staff: r <br />r <br />z <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL DATE: z- <br />n' <br />UPON APPROVAL: APPLICANT M T POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page I of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />C <br />7 <br />'b <br />i <br />J <br />�I <br />i <br />o i <br />o <br />ti <br />z <br />77 <br />o? � <br />c: <br />v S <br />� V <br />I <br />I <br />I <br />s" y <br />z <br />pop <br />MM <br />Fee Rec:�W <br />Check #: Ya 85 <br />