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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line g. g <br /> Permit Types and Fees:(Please,check appropriate boxes) d R` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure / �' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 .- F 21 <br /> Accessory Structure(Commercial/Industrial) $200 �P,ddition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk //"fir k se .____------12p------ ° e 4- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 P, �� <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 cn m y <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E <br /> q <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r g <br /> 0 ci' <br /> a <br /> Property Owner's Name: 6-e( tcl 1)a A no, Zes74 lb <br /> CT <br /> Property Owner's Mailing Address: 3031 Co i,t 4 /' ? tJe kir," O.1 50193 - II <br /> City State Zip <br /> Property Site Address: SA in E 4 <br /> 21, <br /> Contact's Telephone Number:CI /-.0 i6 3-C-137/ o . <br /> Contact's Email: 0-14 G ri ^ <br /> Legal SGC 40.Ge� N '-da1 Description of Property: - <br /> Section#: Town#: N Range#: W Town of: <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* R <br /> Tax ID#(1-5 digit number; found on tax statement): ,gro Ai haul Cn <br /> Proposed Use of Structure/Addition: (Jal k W A.y/£rt JOSS ares Ze y 4.0 St e d 0 X <br /> Anticipated Start Date: (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) ° 0 <br /> Building Contractor: Se i C Sewer Installer: Ai/i1 -t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> G 5M V, z7 6 z6? adifuseici te.reap^ 4'74/4e z .3 <br /> 1-0 Softie- Ill e. o -GoptTv,^iA c <br /> mai^ S . - a�, <br /> h h <br /> -i Fee Rec: X06 <br /> 4 * N Check#: f(ro/5 <br /> / <br /> Date of staff site visit: Initials of site visit staff: X0 3 Za ? <br /> . 'I z <br /> IA/2e <br /> ,` o <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:I 2e a <br /> UPON APPROVAL: APPLICA 4 MUST POST COPY OF ,c7 ' <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r <co <br /> ro <br /> CSS <br /> _5( NilTranscendent: - Page 1 of 4 31 n <br /> Oo 0 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 8/2018 ! c, . �' '-, <br /> ' iii <br /> m <br /> D <br />