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.� <br />LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300rAddition/Alte <br />ion/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300ion/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150ration to Accessory Structure$150 <br />Accessory Structure (Commercial/Industrial) $200ion/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk house $250 <br />Driveways/ & Campground Structures $125ate Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 lBoathouse $500 <br />Six Month camping Unit (One Per Year) $100 1 Permit Extension (1 Year Extension - Allowed Once) $100 <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. <br />Property Owner's Name: C01 I Ce, �. 4r5-p/,j <br />Property Owner's Mailing Address:_y �q -f: /Da <br />City State Zip <br />Property Site Address: 93(',,I( do CCCA111,A �o, IJC`S {�Y- LAS <br />Contact's Telephone Number: <br />Contact's Email: G.t U 1 C.4 r / „ eorrL/ <br />Legal Description of Property::/ Ae T l o' 4 o* .81" k Q� <br />Section #: 3 (0 Town #: 7 )Range #: /,7 W Town of:_4 <br />*Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tar system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: G/` Y �pr' <br />Anticipated Start Date: gl (" ome/CaPjv- Comqercial Business: Bedroom; Deck. etc.) �r'�/ ��CF <br />Building Contractor: S(�t�P.�'l�r� Of Sewer Installer: Tae�Go+✓ 6t►�1 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDIT11ONS LISTED BELOW: <br />c, Co~ cYc <br />ro e� �" ` (1 t 5 s V CVT. 2 2 �vt a i� SGi��V f <br />a S <br />If -r- ould a� wlml/� a co y <br />ollo� (� u^>noUf 3 <br />F U�� 4 se��,v 11d—�s,-�O <br />V� N `y'OUVO Date'of staff site visit: Ini iais I site vSL: k56 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: -""—__ DATE: 0 L <br />UPON APPROVAL: APPLICA T MUST 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 />S I {t V I IV- o ff / 0/I L�I � 1Q1 <br />2 <br />S <br />ro <br />U <br />2 <br />J <br />C <br />0 <br />0 <br />7! <br />2 <br />1 <br />Fee Rec: 1 <br />Check #: t� <br />N-l<;t.r v, Sw' LTS iw <br />