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i <br />pla <br />LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropr <br />Dwelling/Principal Structure <br />ddition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Stru re <br />Addition/Alteration to Commercial/industrial Structure <br />$200 <br />' <br />Accessory Structure (Garagk Shed, etc.) <br />$15 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Comm eraa n us r a) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />jWl State Statu Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />113oathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />jPermit Extensio ear Extension - Allowed Once) <br />$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:V k7� L-- C. *ST4 <br />Property Owner's Mailing Address: 4110 C150A ft- L44<4 P!►S MN SS'-Ar-1 G <br />City State Zip <br />Property Site Address:.. �+7-40 M I M&I SM I r* W <br />Contact's Telephone Number: %*0,tij 141 avowy���~Z' 9 �" <br />Contact's Email &41%V G' tiwi.%44*M10 - aRG <br />Legal Description of Property: 5 42.8' nG Clov L.01` 3 _ <br />Section #:� Town It:4V N Range #: i �► W Town of: <br />tat system properly page. <br />*attach additional page if neededfor lengthy description OR allach n copy of the deed OR alt713 <br />'Tax ID # (1-5 digit number; found on tax statement): 139 StA 3 9-f-7 <br />Proposed Use of Structure/Addition: ceArM P W*WAX- i4 i T1 U I V 6-f� <br />Anticipated Start Date: 4P 12.L_1 U t I (lfarre/Cabin; Commercial Business; Bedlrown Deck; etc.) <br />�p �,t�i; 9t *ore- f0 <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMIN1ENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />b&a7%ou,4e-- 1 � 2. q*1Q 4ZaA'\— <br />`1 C4-) , <br />%•� l5 / 9 a150 i'n�" �ite. h� �a/�'-� a cc eSt S�7^LtC�N�°5. <br />• V,,o OaYrti(S Sm G4YN l�wt�f.. A hew (ooa7GjoGS� mN 2.4c�ij �qi^� <br />Date of staff site visit: 3 Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL,: _DATE: Zg� <br />UPON APPROVAL: APPL CANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION M PLAIN SIGHT <br />Transcendent: �- -_ Page .l Df <br />Laserfische: _- Burnett County, WI Land Use Application - Rev 1/2019 <br />--i <br />z <br />X <br />Fee Rec: / rTO <br />Check #: VP " 1 <br />m <br />y <br />z <br />r <br />r7 � <br />a <br />0) ca <br />D <br />—� <br />r <br />{ QONJ <br />N <br />C2l <br />C <br />cc <br />V <br />loll <br />