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LAND USE PERMIT APPLICATION—Burnett County, WI 10 <br /> b <br /> Applicant Complete All Sections Below This LineCD <br /> o <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) d� <br /> Dwelling/Principal Structure J$200Addition/Alteration <br /> ddition/Alteration to Dwelling/Principal Structure $200 _ <br /> Commercial/Industrial Structure ddition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) ddition/Alteration to Accessory Structure $150 \ <br /> Accessory Structure(Commercial/Industrial) to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalkunkhouse $250 0Driveways/&Campground Structures I State Statute 59.692(ly)Structures $350Filling/Grading oathouse $500 0 <br /> Six Month Cam in Unit One PerYearp g ( ) ermit 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:pergolas,landscaping,etc. r <br /> o <br /> z <br /> Property Owner's Name: �d �� A Q yS e.+-L- T � <br /> Property Owner's Mailing Address: -75S k�Kkr2- <br /> City State Zip <br /> Property Site Address: g 1100 C1r R <br /> Contact's Telephone Number: 6 0115''3 39 cl C.P/d e-W c9 p 11V <br /> Contact's Email: Qt`L- P—e,!— S•�Y N V` s K.Com <br /> d <br /> CD <br /> Legal Description of Property: 66V f Lp/1 d o IQ <br /> Section#: I C1 Town#: J4 N Range#: 15 W Town of: 0C -&P'rj UQ <br /> C7 <br /> *Attach additionalpage if neededfor 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 /> a <br /> Anticipated Start Date: "(2/"aZ0 (Home/Cabin;Commercial Business;Bedroom,,Deck;etc) (�) j <br /> Building Contractor: od tl �U)&-h Sewer Installer: �/f <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> r� <br /> T�HIS PERM IS S�2UBJ �TO�NIOAt LISD�PEIJ.OW: z v1 <br /> s Fee Rec: <br /> Check#:.� <br /> d <br /> Date of staff site visit: I itials of site visit staff: L7( a <br /> z <br /> APPROVED BY LAND SERVICES OFFI I DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> V <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a <br /> Transcendent: - M 00 <br /> C o <br /> Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 CD <br /> o <br />