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CD <br /> LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> a <br /> C7 <br /> Per it Types and Fees:(Please,check appropriate b ?: <br /> Dwelling/Principal Structure $3 Addition/Alteration to Dwelling/Principal Structure $200 Q� <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �f <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $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-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. o <br /> Property Owner's Name: 0 L1.�SCJ� <br /> Property Owner's Mailing Address: o -6,141'etc- �.',j (�L �r �� �� a %J <br /> City State Zip <br /> Property Site Address: (SGl Gjk,,1 rih,& <br /> / <br /> c <br /> o N — <br /> Contact's Telephone Number: ( � 3 7(- (C1 N a C� <br /> 0/ t7 Contact's Email: �%�Cy t ',L(�-03� ( GJ t - C u-q G <br /> Legal Description of Property: L Z C SM� i ,s 3(J (l 25 t�63 l� � <br /> w <br /> Section#: 01 Town#: ?1ALN Range#4,i—� W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deedOR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): ? � 71f J��ta 19 „ <br /> Proposed Use of Structure/Addition: <br /> 0 <br /> F <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) o C7 <br /> Building Contractor: L-e lt(y //.,,, (DIP 20 Sewer Installer: tz�cx_ IP-i � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> UJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> y Aeali <br /> Fee Rec: 'r �- <br /> y Check#: a,j jo3 <br /> Date of staff site visit/0— ` ! Initials of site visit staff: a <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> � (Duo <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> ° W� ^' rilr <br /> to � CAI: <br /> Transcendent: - Pa e 1 of 4 -0�_ Cz <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 <br /> y <br />