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-o <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o <br /> Cl. I <br /> Permit Types and Fees:(Please,check appropriate boxes) _d <br /> L1,welling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �r <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> v Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Ca <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C- <br /> Filling/Grading $150 Boathouse $500 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 `n <br /> ,, <br /> 0 <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. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- g <br /> Property Owner's Name: "VN_ �7.0 / Z <br /> . L//� 5C1� z <br /> o . <br /> 74 <br /> Property Owner's Mailing Address: /4105( ,2e.),;?'''''5-7- A) 4r& /IA 53a€:/--) <br /> 10City State Zip 5 n <br /> cn <br /> Property Site Address: „Z.26 94/ ^�Jn4/.s,,.,, /el �e /C, Gt✓' / 5?e 3.7 4 <br /> Q <br /> Contact's Telephone Number: (6,6-i 5`-7 Sj ? c c <br /> _ <br /> ci <br /> Contact's Email: s .Su/✓ 65 o <br /> Legal Description of Property: LO l 1 c.Q MA" k.. f(F Vic P 1 b 5 (CoG U /fitAT, E.m <br /> t., '.o k�E�1 o Q <br /> Section#: 35 Town#: b Ni N Range#: k 5 W Town of: ,'r--4)1/0 ' <br /> u. <br /> *Attach additional page if needed for 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): 10/97 <br /> Proposed Use of Structure/Addition: ddliaihhiis.. /y6.0p,e,ge. 4 14000 a . <br /> Anticipated Start Date: 5 420„?u (Home/Cabin:Commercial Bu iness:Bedro :Deck:etc.) p <br /> Building Contractor: T�� Sewer Installer: 1—g i, ` - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIScr- <br /> PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Perm;4- , a.(-a-1 2 a"..4 he sh 4 z <br /> , ,,-c\cc,'(\-- --ck:‘ • \ I D LJ'd&E s ,b0,QJK5 <br /> H Fee Rec: /- <br /> Check#: Let/7(,+ <br /> \ ,— OP /0 o <br /> Date of staff site visit: 1 Initi, of sit• visit staff: `A .' 4'1-- <br /> • <br /> — <br /> APPROVED BY LAND SERVICES OFFICIAL I DATE: "--3-.7-0,9b -_ —"-`� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ^�` o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 - iv <br /> m <br /> iiiiii <br /> m e r•, c' <br /> Transcendent: - Page 1 of 4 ,<v <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 0 Ira <br /> LL '-)1 <br />