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LAND USE PERMIT APPLICATION—Burnett County, WI LID <br /> Applicant Complete All Sections Below This Line b <br /> a � <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> w <br /> Dwelling/Principal Structure I <br /> Addition/Alteration to Dwelling/Principal Structure $200 q <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure Gara a Shed,etc.) Addition/Alteration to Accessory Structure $150 N P <br /> AccessoryStructure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 c \ \ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures WI State Statute 59.692(Sv)Structures $350 r <br /> 0 <br /> Fillip Gradin Boathouse $500 <br /> Six Month Camping Unit(One Per Year) jPermit Extension(I Year Extension-Allowed Once) $100 a' <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 /> 0 <br /> z <br /> Property Owner's Name:/f RoM f} �p S R. Cum& 9 p <br /> Property Owner's Mailing Address: 4Q66 N SS12LS `J <br /> (� City tate Zip a' <br /> Property Site Address: 168(o 71)" IS R04C9t U-JQltltkuA W= 54189 A <br /> f o <br /> Contact's Telephone Number: 6 ( - 7 35-Zo 1`7 <br /> Contact's Email: 4111mm Iq e CQM`�LUua�cuY�. •j'a» <br /> Legal Description of Property: 45- :Z <br /> Section#: 514 Town#: _N Range#:A- W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 8�� <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date:_ 5617.00 (H a/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> NQ�S N AN u�ER1oR G©lu6T• y <br /> Building Contractor: .Ey 0.4 R o Sewer Installer: N I P, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUB.JFCT TO ALL CO TIONS LISTED BELOW: <br /> rl�L� <br /> I v� <br /> Fee Rec: <br /> cb <br /> Check#:� 5 <br /> L'20doIN <br /> Date of staff site visit• —>' Ini 'a of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICI DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT al <br /> � rt <br /> Transcendent: - Page 1 of 4 00 +� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 L <br /> r <br />