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LAND USE PERMIT APPLICATION—Burnett County, WI Cr b <br /> Applicant Complete All Sections Below This Line �o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Pr nci al Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> AQeessRry Structure(Commercial/Industrial 00 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio R idewalk Bunkhouse $250 <br /> Driveways/&Campground StnIcture, <br /> IWI State Statute 59.692 iv Structures $350 r- <br /> 0 <br /> m $150 1 lBoathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1 jPermit Extension 1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fad permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as;pergolos,landscaping,etc. S <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: 1 7 2-2 C7 y12 e"F_`C rz5$ $ <br /> �'✓t rt x q-74o.4 A ., /11^1 5 5 3 ' ity State 'Lip LA � <br /> Property Site Address:34e 23 Lor-, L Al-E APV�-f2. <br /> � <br /> Contact's Telephone Number: 4e 5/ -3 7 3 — 41Q q a <br /> d <br /> Contact's Email: -/-h'-/``7 0 R.Ct. z, 57 t1i 4 L <br /> Legal Description of Property: �fF Ah,I G�(E c-/ �i4 k -67 T�ltit <br /> Section#: 0% Town#: `f0 N Range#: i 5 W Town of: -1-R C-A SSA o <br /> r7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o• <br /> Tax ID#(1-5 digit number;found on tax statement): �'/' 9 7 3 <br /> Proposed Use of Structure/Addition: 6ftxnoQq e <br /> f <br /> Anticipated Start Date: S IQ r Z/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc) ° p <br /> Building Contractor: 9't-X 4DA 5 Tie L)c.7-/L*3 l Sewer Installer: inlAcIf RO. 6 h o`m SAP Pt , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: c ZY y Check#: <br /> � 0201 <br /> Date of staff site visit: Inil I site visit staff: a <br /> e <br /> APPROVED BY LAND SERVICES OFFICI L: E:! < r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y Q <br /> a 0W rn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> (D - <br /> (D 0 crs <br /> 00 >o <br /> Transcendent: Page 1 of 4 m o <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 W <br /> a 51) <br /> b <br />