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CIO <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line �o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> ILK <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 C. <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One PerYear) $100 Permit Extension(lYear Extension-Allowed Once) $100 <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. �o C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. R <br /> z <br /> Property Owner's Name: I C#,4 h 0,4' L//fZ&A,'/4 Q,!�L L , <br /> Al i T'J' 4 z. Y3- 7-2 o �� <br /> Property Owner's Mailing Address:t 7 0 G 6o N• CG L ©1,1 S / (:1 / 0 <br /> City State Zip <br /> Property Site Address:o;2So2 7.> S Pif q z,D/ti G' rz d, (T fMA/7,f 9g1Z UJI• 6�4110 (ZS <br /> Contact's Telephone Number:.57:;;10-7�f 00.3^7S O 7 n <br /> p <br /> Contact's Email: ! Nov YGoW!r/—, GqS'rV <br /> '• G t cSM V z7 /03 <br /> Legal Description of Property: (�'2 •-04z) — P _3 2 —� <br /> Section#: 27 Town#:�N Range#: c W Town of: lA) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> o <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONENIENTS/CONDITIONS ONLY <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> S VlA 10 Joe (A$dA1 For hV W aVt 1'to4toYl z --o <br /> Fee Rec:� <br /> Check#: <br /> Date of staff site visit: & ) Initials of site visit staff: <br /> r � <br /> APPROVED BY LAND SERVICES OFFICIAL: 4��`ATE: 1 <br /> CD M <br /> 3 <br /> UPON APPROVAL: APPLICANT., ST POST COPY OF <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N cm <br /> z �c <br /> Transcendent: - m <br /> Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> m <br /> 0 <br /> a <br /> 3 <br /> v <br />