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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 />Dweiling/Princi at Structure 1$3001 Addition/Alteration to Dweliine/Princinal Stmlhlmo I tl" <br />_�___ _.. , , a,a ,,,�,, C,�• <br />Structure Commerclai/Industrial <br />Deck/Stairs/Patio/Retaining Wail/SidewalkBunkhouse <br />s/ & Cam round Structures <br />t illin Gradln <br />I <br />ACRIMOn/Alteration to AccessorySiructure <br />Addition Alteration to Bunkhouse <br />$150Accesso <br />$150 <br />$y50Drivewa <br />Wl State Statute 59,69 iv) Structures <br />Boathouse <br />$350 <br />$�Six <br />Month Cam 4 Unit (One Per Year) <br />permit Extension (1Year Extension -Allowed Once) <br />$gyp <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: er olds, landscaping, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address: 3 i 5 ( <br />�' f�✓� r , C tOteb'r ,�J <br />/ZL ; <br />Property Site Address: �76-3-Ax-4,_e <br />City State Zip <br />/P A k, <br />Contact's Telephone Number: („ I2. - ,9 6 <br />Contact's Email: _-te)mmgi r t � A � coven <br />T -#.1.6 <br />Legal Description of Property: y'i L ( C3ji'),A— f a 3 �7 ((xw Le�5 SZty1. C-.6v lai <br />5 2107 <br />Section #: Z -) "Town #:_ r{ ! N Range #: 1 S �W Town of <br />*Attach additional page /fneeded for lengthy description OR attach a copy of the deed OR attach tax syslejn property page. + <br />Tax ID # (1-5 digit number; found on tay stntement): <br />Proposed Use of Structure/Addition: ' _ �.:1,4 Cxlad. A,,z z rho c/ <br />Anticipated Start Date:_:5 ,._ I sj (Horne/Cabin; Conrarerclal &abtess; Bedroom; DecA; etc.) <br />Building Contractor�'c �k_e1p I(ej k�- ,,hlrrs sewerimualler�yTE <br />AREA BELOW THIS LIINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLBELOW TNISLINE FOR LANTD`3'ERVICES STAFF CF MEN/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of site visit stab: / <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: �d <br />UPON APPROVAL: APPL CANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: _- Page 1 of 4 <br />Laserfische: Burnett County, WI Land Use Application — Rev 1/2019 <br />n r <br />5 <br />it <br />r <br />q <br />m <br />0 <br />r � <br />a <br />n <br />o <br />S. y. <br />�r <br />N <br />o � <br />z <br />I <br />Pee Rec: <br />Check #: <br />C <br />CL <br />0 <br />U�z <br />Do <br />o <br />o c <br />_A <br />3 <br />(D <br />� <br />pUu <br />