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LAND USE PERMIT APPLICATION-Burnett County, WI b <br /> Applicant Complete All Sections Below This Lind 7 y <br /> 0. <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwellin /Principal Structure $300 Addition/Alteration to Dwell in /Princi pal Structure $200 <br /> Commercial/Industrial Structure $30C Addition/Alteration to Commercial/IndustrialStructure $200 <br /> AccessoryStructure(Garage,Shed,etc.) $150 Addition/Alteration to AccessoryStructure $150 <br /> AccessoryStructure Commercial/Industrial $200 Addition Alteration to Bunkhouse $150 ~ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692 lv Structures $350 <br /> Filling/Grading $150 1 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 w <br /> *NOTE:After-the-fad permits(permit aquired after construction has begun)may cost up to three times the normal fee. LA <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. R. <br /> V G �f z <br /> Property Owner's Name: 140p/n—ws, %i rmp OL 6alawg-- o <br /> Property Owner's Mailing Address: `77&b 4m, b ^ <br /> City '"� State Zip ^ <br /> Property Site Address: 5A ME ���SfF1Z Vr 1 5"53 'n <br /> Contact's Telephone Number: <br /> Contact's Email: 14 LK @/ Ky w-� 5c,m a-• Wft <br /> IV Legal Description of Property: W J W o m <br /> Section#: A-0 Town#: 4-0 N Range#:t_AN' Town of: Olk KL Ko <br /> t7 <br /> *Attach additional page 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: tom e- f 5i}rc Fh p t#tl Tl <br /> Anticipated Start Date: Z- (tlomeXabin,Ctmmercial Business;Bedrr m;Deck;etc:.) � a <br /> Building Contractor: tjE W �U1tI .Rs SewerTnstaller: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .. <br /> z <br /> a <br /> Fee Rec:.Iz� <br /> Check#: 6501/p <br /> Date of staff site visit: -tials of site visit staff: <br /> APPROVED BY LAND SERVICES OF ICI AL: " <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y <br /> D: <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> a <br /> CJ <br /> Transcendent:= Page I of 4 <br /> Laserfische:_- Burnett County,WI Land Use Application—Rev 1/2019 m hrl <br /> ar00 <br /> ll LI <br /> N al C PIZ <br /> 3 COY tl u iJ <br />