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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Cornplete .all Sections Below This Line <br />Permit Types and Fees: (please, check appropriate boxes) <br />Dwelling/Principal Structure $300Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300r,Wl <br />Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 State Statute 59.692(ly) Structures $350 <br />Filling/Grading Isiso I Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 1 Permit Extension (1 Year Extension - Allowed Once) $100 <br />"NOTE: After -the -fad 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: i—O� v^ 11 (N-1\ 10 P0% t L, I A S Lj l`4 v , C. /^ <br />� S Soot <br />Property Owner's Mailing Address:2-1 1 i T^f'as P�yi TV0, +.. Sc. Q►elan MN <br />City State Zip <br />Property Site Address: O C6 W . e o i�4. W; <br />Contact's Telephone Number: kc3 1 Z r8 -1 1 - O'L <br />Contact's Email: I -n S, C) o <br />Legal Description of Property: R\") C., Dpi + L <br />Section #: Town #: LIQ N Range #: 144o W Town of: OGk 1-\ tem C� <br />"Munch additional page if needed for 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): 1 3 <br />Proposed Use of Structure/Addition: `S{ D M 0,A-- 1PU r r> o UA -.1- fN,,fN,1 C, A r A.0 -V(-, ;-3 Cct r� <br />Anticipated Start Date: 5 % 2 o U q (Hattie. Cabin, Connuercial Business: Bedroont: Deck. etc.) <br />Building Contractor:-t•l �'} e� Sewer Installer: <br />-RiAREA BELOW THIS LIVE FOR LAND SERVIICE.S STAFF COMMENTS16'®NDITIONS 011 LV <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Ini 'aIs of site visit staff: I <br />APPROVED Bl' LAND SERVICES OFFICIAL: DATE: - <br />UPON APPROVAL: VAL: APPLICAN UST POST COPY OF <br />SIGNED PERMIT APPLICATION Its PLAIN SIGH' <br />Transcendent: _ Page l of 4 <br />Laserfische: _- Burnett Countv, WI Land Use Application — Rev 1/2019 <br />r <br />^ V <br />l - V <br />v Q <br />�> r <br />A <br />o <br />n _ <br />m J <br />V� <br />Cr <br />z <br />c <br />0 <br />U <br />b <br />x <br />f. <br />�r q, s <br />Q j <br />z 7 O <br />X <br />Fee Rec: 60 <br />Check <br />v <br />r w <br />a <br />TCDW <br />CD tJ1 <br />Oo <br />cD c N <br />w w CD <br />w <br />CD <br />