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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ° c <br /> t7 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> CD <br /> Dwelling/Principal Structure $3001 1 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $3001 1 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etlk <br /> Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Ind Addition/Alteration to Bunkhouse $150 \ <br /> " N <br /> Deck/Stairs/Patio/RetainingWall/SidBunkhouse $250 °e <br /> Driveways/&Campground Structures WI State Statute 59.692(1v)Structures $3500 <br /> Filling/Grading Boathouse $500 ,t) <br /> Six Month Camping Unit(One PerYear) 1$1001 1 Permit Extension(1Year 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. ' r �, <br /> o <br /> z <br /> Property Owner's Na e: ,,a I-rel-rd 4 i171 <br /> • o <br /> Property Owner's Mailing Address: r !<� a <br /> � <br /> City)qa&-j-jXAate1nj&ip3 <br /> Property Site Address:/V/4&4a2oi ,Rd <br /> Contact's Telephone Number: 0ay <br /> / P C) d <br /> Contact's Email:p Lir ' n-f5( ��mC���I')'1 e l� 2-4�j @�r�- <br /> Legal Description of Property:-�eL 90 Tn 3�) RrA&19 3%A SD 'a- $�1 <br /> Section#: Z—� Town#: N Range#:�—W Town of: � c.- " ff')�rSv�n� °G <br /> d <br /> *Attach additional page if needed for lengthcripon OR attach a copy of the deed OR attach tax system property page.* 2 <br /> Tax ID#(1-5 digit number;found on tax statemenn . o <br /> Proposed Use of Structure/Addition: o',y 4o � x <br /> Anticipated Start Date: (Ho /Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> z <br /> Fee Rec:42 <br /> ICoo? Check#:k-142Z <br /> 0 <br /> m <br /> Date of staff site visit: Initia site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL V`o'� CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF .�, 95 <br /> rn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °D <br /> r-s <br /> Transcendent: Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 cm <br /> 3 <br />