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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line o <br /> ^tom <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure d$2OO <br /> `' Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $ISO <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o <br /> Driveways/&Campground Structures WI State Statute 59.692(ly)Structures $350Filling/Grading Boathouse $500Six Month Camping Unit(One Per Year) Permit Extension(1 Year Extension-Allowed Once) $100 w <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. 3 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o J <br /> Property Owner's Name: 'O ` ' ,� CA � �� C\��6.6 3 P— o_ <br /> 1� cb Q <br /> Property Owner's Mailing Address:�� � �i�,� +`�', �� i,;c:T+.5 L .0 <br /> City ` State Zi <br /> Property Site Address: 5 m l e <br /> C N <br /> Contact's Telephone Number. �rj 0 <br /> Contact's Email: V 5 Sd1�1 CAY1\ �'M � + ' L C�i'� r <br /> _ L L.c*31 �3d <br /> Legal Description of Property: 1 C�C��Z� S D 1 cyC,5 �U� 1 C V C�N ck ciye r <br /> Section#: 57t Town#; %Range#: ►S W Town of: J AC k',SG+`1 OQ <br /> t7 <br /> *Attach additional page if needed for lengthy description OR attach acopy of the deed OR attach tax system property page.* , <br /> Tax ID#(1-5 digit number;found on tax statement): `9 `n' (D T <br /> Proposed Use of Structure/Addition: Gc\f \-- /S� -e 0 <br /> Anticipated Start Date: �`` C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �l d <br /> Building Contractor:�3'c711 E' CC, n 1�e5 I C_Z � Sewer Installer: v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> rT f- �P f� PLct- <br /> 0 11-0 6' � Y ►'� �- r �a 1'� <br /> m <br /> s <br /> Fee Rec: — <br /> N Check#: c2/R <br /> Date of staff site visit:;? / ` I ' 'als of site visit staff: V <br /> APPROVED BY LAND SERVICES OFFICL� <br /> DATEi=—� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF -� <br /> rn <br /> a � a) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT onn . � <br /> c <br /> Transcendent: - CD C <br /> Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 m K ® <br /> b <br />