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LAND USE PERMIT APPLICATION — Burnett County, W1 <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$2DO <br />Commercial/Industrial Structure <br />$300PWI <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150Addition/Alteration <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200Addition/Alteration <br />to Bunkhouse <br />$ISO <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />State Statute S9.692(ly) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />IlDermit <br />Extension (1 Year 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 betreate/d� as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 'et�J e-`t--{- %rel//��\ <br />Property Owner's Mailing Address: A 1 V"e KC h, vLv—tS0 ev J0 <br />q i n 4'ity State Zip <br />Property Site Address: ( 0-7 �` vl t� 1 `Ci` F ray%-L I Lim A 1, <br />vt ! d`` <br />/,Pq <br />��i <br />Contact's Telephone Number: 1— `i — 4 ,5-9 cS <br />Contact's Email: S C k i e—t % Q ke% !�e-,r/ - C D vv\ <br />Legal Description of Property: 1 -�{/� <br />3 I /V P°(�yL) <br />e <br />Section #: 3 4 Town #:3 11 N Range #: r W Town of: 141ZSYf <br />*Attach additional page if needed for lengthy, description OR attach a copy of the deed OR attach lax sYslenz property page. <br />Tax ID # (1-5 digit number; found on tax statement): 9 / 1 4 <br />/ <br />Proposed Use of Structure/Addition: R &+kro o w. Owe/.c .?- 1,4rcyTv-►n C 22 t ,x AV t <br />Anticipated Start Date: 4.5 .94Q (Home. Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 60Wkt7a k1 Co y1s7', Sewer Installer: 40ol4.ns <br />�i��:.^� LL' LV �• L1110 Llllri c Vli LtA"" Jr z%�' "GJ J lHf r 1, V1q 1�1 Pi1� lJ/1.V1�Ll I IVl`1 .7 Vl`IL Y <br />THIS PtERMIT IS SUBJECT TO AL/_L CONDITIONS LISTED BELOW: <br />Q 17, <br />C--4 C $ So r v S�7iU ii�2 <br />qH goo s� �y 6130 <br />Date of staff site visit: <br />APPROVED BY LAND SERVICES OFFICIAL: <br />UPON APPROVAL: APP <br />Initials of site visit staff: / <br />(2 �� <br />DATE: 's " <br />(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 />T <br />0 <br />0 <br />a <br />c <br />5 <br />N <br />3 <br />`U n <br />Fee Rec: <br />Check #: <br />D <br />00 <br />lV <br />O <br />to <br />9 <br />ULI <br />