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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> r <br /> Applicant Complete All Sections Below This Line N <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> J*N : <br /> ng/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> ercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> ory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> ory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> tairs/Patio/Retaining Wall/Sideway t Bunkhouse $250 <br /> ays/&Campground Structures 5 WI State Statute 59.692(1v)Structures $350Grading $150 Boathouse $S00nth Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100-the act permits(permit aquired after construction has begun)may cost up to three times the normal fee. C1� <br /> • drFrg-a I � .rt1— <br /> *Items not listed above will be treated as accessory structures,such as:pergolaas,landscaping,etc. <br /> Property Owner's Name: `'� '2� <br /> Property Owner's Mailing Address: 2-0 3© 1-S+L-1 Phvve I`-)E N1m(--3 S <br /> City State Zip <br /> Property Site Address: 30(pL}'� � � �--� Dr. �a r,l� f W.T- 30wx,--i <br /> Contact's Telephone Number: `I L0 3 4L"A- 111,P5 <br /> _a <br /> Contact's Email: Cj0L)Qa hGi } � LJ� rvo2 n .Coo-� ° <br /> V (W/f Srr%4Al3il <br /> Legal Description of Property: LAST' 3 C S ryl+V at BA V IQ P 17 b C—IOV L.C)KS 2•P 3Ao 1 t 2 0 W <br /> Section#:tg_Town#: q-- 1 N Range#:_ 1�W Town of. Sl�l�tSS <br /> ° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number; found on tax statement):_ 2 1 Lp <br /> Proposed Use of Structure/Addition: �� <br /> t <br /> Anticipated Start Date: D (Home/Cabin,,Commercial Business:Bedroom:Deck:etc) p <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �1►S %S r► A�Tvr' '/vI G - P'�" <br /> z <br /> Fee Rec:,20DC—D <br /> Q T s Check#: <br /> Date of staff site visit: Initials of site visit staff: <br /> > <br /> / z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �/ z <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCL <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zCn <br /> g N <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2019 c <br /> T (� <br /> D Q <br /> i `rI <br />