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r <br /> LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line o cn o <br /> C7 ist <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 ><Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �G1 <br /> JrAccessory Structure(Garage,Shed,etc.) $150 .;1' ddition/Alteration to Accessory Structure $150 :; <br /> Accessory Structure(Commercial/Industrial) $200 ' Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r i <br /> g <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. l <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. o <br /> LA z <br /> Property Owner's Name:JO km A U D 6,it -= <br /> � ;� t o <br /> o <br /> Property Owner's Mailing Address:3 �9 a tom! Zvr(1P)Sarr 1 k /�n C c�I{�lbvicet N/ 62/Oat <br /> City (9tate Zip d. n <br /> Property Site Address 9 a r„) lur r It o., A,o„ut, ( le— ilk ZA.uiwir+s Apr ,--S—q$3 a E <br /> Contact's Telephone Number: 4 /(2-325'7- 5. le C9 a <br /> e <br /> Contact's Email: J C.H 6 1 a-q?OUJT LOOK•C-01/1" P.CO <br /> Legal Description of Property: F i-s i AD-D fig &00. ,, (eA A?c45 FOf 01-3(2 a �o <br /> Section#: 3 p Town#: 44 I N Range#: /S W Town of: 5;,„d s °O <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> il- <br /> Tax ID#(1-5 digit number;found on tax statement): „99,g3i, a .1c3,1 v, <br /> 5lj.� 1 Gc d de*c� • <br /> Proposed Use of Structure/Addition: �iAc-� l i <br /> Anticipated Start Date: =I-9.0 (Home/Cabin;Commercial Business; droom;Deck;etc.) C) <br /> • <br /> H <br /> Building Contractor: 1,0, •kvb&• ' Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY %_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: • <br /> z <br /> ��Q\�� N. 1 S -- --k-- Sha��Va� S lO�c _�-- po <br /> ��tedui pVti-- kck-Y\ <br /> ` 6-e o r Fee Rec: L0 <br /> U 7' Check#: 500 <br /> o <br /> Date of staff site visit: /16 �� Initials of site visit staff: 14e---.. --- r- <br /> z <br /> / cn <br /> G C <br /> APPROVED BY LAND SERVICES OFFICIA' • ,_,L4 i DATE: -�` ���Q:2G <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a a WL'ji <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z y erto0 <br /> Transcendent: - Page 1 of 4 w <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 3 <br /> rz <br /> cvc0 L-__=.---) <br /> b <br />