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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 />Dwellin Prind al Structure <br />$300 <br />Addition/Alteration to Dwell in Princi pal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Drivewa s/ & Campground Structures <br />$125 <br />Wl State Statute 59.692(Iv) Structures <br />$350 <br />Fillin Gradin <br />$150 <br />1 <br />18oathouse <br />$500 <br />Six Wnth CampingUnit One Per Year) <br />$100 <br />1 <br />1 Permit Extension 1Year Extension -Allowed Once) <br />$100 <br />'NOTE: After -the -fact permits (permit aqui red 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 />olds, landscaping, etc. <br />"Items not listed above will be treated as accessory structures, such a11 <br />i�s: 'r/ <br />Property Owner's Name: .3 L\ Ci O n CLr\ A Cx Y cl,. Lee, <br />L <br />Property Owner's Mailing Address: I cb`(o 5 i'(I'I k2 Rd kA 59540 <br />Property Site Address: icp3G(6 c4fyJ �(A �rC�pl City fate Zip <br />Contact's Telephone Number: )CLSoi\ — 5e7-25C -2735CCell) i1S--6Sgr-2Secl <br />'• <br />Contact's Email: t LL SG Y� F Cx Y I e e hG i Yi0 i I CO a +'�1 <br />Legal Description of Property: 1 6+ 1. C'y iM VZ Z (111,4 <br />Section #:'5 ( Town #:___-35_N Range #:_ I W Town of: Ot)tNd give_V— <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />3 22 3 <br />(0 <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: GCk Y a'G£ j .51 i C r c, Q, <br />u a Anticipated Start Date: AZ(e 19 (Home/CAW Commercial asiness; Bedroom; Deck; etc.) <br />Building Contractor: T G � j T— <br />Sewer Installer: N A <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTSICONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDIITION LISTED BELOW: <br />AA f (f <br />�- /Uo� �De U S �►^ u wi �►� a �r74]7e)1 <br />Date of staff site visit: 6 ZA Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: ATE: <br />UPON APPROVAL: APPLkANi646T 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 />o <br />� v <br />N <br />z <br />Vv <br />Fee Rec:,�CJ <br />Check #: <br />r <br />G� <br />CL <br />0 � <br />>~ (( )) <br />N <br />oa <br />(DC <br />m <br />7 <br />Y Y Y <br />