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LAND USE PERMIT APPLICATION—Burnett County, WI 9: 9 b <br /> Applicant Complete All Sections Below This Line If <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Princi al Structure d$3 <br /> Addition/Alteration to Dwelling/Principal Structure $200 r` <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 yJ <br /> AccessoryStructure(Garage,Shed,etc. Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> I� <br /> Driveways/&Campground Structures WI State Statute 59.692(1v)Structures $350 rFilling/Grading Boathouse $500 <br /> Six Month Campin Unit(One Per Year jPermit Extension(1 Year Extension-Allowed Once) $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 be treated as accessory structures,such as:pergolas,landscaping,etc. C. <br /> �] jJotd-Aczlm <br /> / o W <br /> Property Owner's Name: 14)e�r �r/ADM el- r//' It�ZY'j D�/ I <br /> // (( EL <br /> Property Owner's Mailing Address: Z 73 77 /cLT , h IJe®sip h) s` 9 i3 <br /> City State Zip <br /> Property Site Address: ��/D�c 6t- K <br /> o N� <br /> Contact's Telephone Number: <br /> Contact's Email: kie/®A.-keo ! j MG,,1, ,r PM � <br /> Legal Description of Property: //t~ l�l P �5 Li %h [ I(,l J� 7 N ° \"9 <br /> Section#: 2�f Town#:---qiP N Range W Town of: �,/ tC-/<�-JPAI <br /> d \ <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 /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 0 C t, -er// (Home/Cabin;Commercial Business;Bedroom;Deck;etc) ° C7 <br /> g ` /' IdFi`s Sewer Installer: �,rdEl1A 1, y <br /> Building Contractor: � �@K ui <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> z <br /> � I <br /> Fee Rec:� <br /> Check#: 54-ol0 <br /> LA <br /> Date of staff site visit: "/ M Initials of site visit ff: <br /> o <br /> APPROVED BY LAND SERVICES OFFICI <br /> A_ W <br /> UPON APPROVAL: AP ICA UST POST O Y OF <br /> Q. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z �0 <br /> Transcendent: - v c N <br /> Page 1 of 4 ? o <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/2019 '` <br /> m <br /> O � <br /> a <br />