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LAND USE PERMIT APPLICATION - Burnett County, WI a c, <br /> g <br /> Applicant Complete All Sections Below This Line s 0 1� <br /> o <br /> O I <br /> Permit Types and Fees:(Please,check appropriate boxes) k'<...\ <br /> G1 <br /> Dwelling/Principal Structure $300 n Addition/Alteration to Dwelling/Principal Structure $200 D� •-.3 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> c� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C1 <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 /> Filling Grading $150 Boathouse $500 --- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 �' <br /> a <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. rl, , , <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. (-o • <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a y <br /> z <br /> Property Owner's Name: �•�Ct-►�t ` 2 l (,oma. -C:_L. p ID <br /> o 'III <br /> Property Owner's Mailing Address: 'j 2 5C,t t,,,,v e- }'K(,.�. 14 'VT u J MM i 3i OZ, .5_ <br /> City State Zip E. n /\4 <br /> Property Site Address: Zy 5. 1 C irC,rt 1)-_✓►rtin- NtC&vSln (2P v\i 2Y t-c4,, Y\1( 1013 ` <br /> it <br /> Contact's Telephone Number: Cg S n 2-9 2 ((11 C <br /> d <br /> Contact's Email: jf}(rjy-e€90C4vi y'1 e 31ry7al I • COw1 <br /> Legal Description of Property: LOT 2, C S Pi U. 1 i pq a 16, N O <br /> Section#: 9 Town#: 3g N Range#: IS W Town of: La t-o Ile+fe- o- <br /> r <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): 9 3 SO v, <br /> Proposed Use of Structure/Addition: S C,Y e t-n_e_a pur 1 i (�,C( (G_ �J�-I X <br /> Anticipated Start Date: )C%}J VIr" u(115f (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° e- <br /> Building Contractor: 7 C.1"if elI 5 CA,--)V(,UY�.WI Sewer Installer: }V JV} <br /> F— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> V <br /> 4— dTHIS PESTfSeewBeST TO-Aia0VITIONMISTB� LO,W:a° a .C. Q z <br /> • ' e.el rc` • /NICr . £�ccee0003 <br /> / A <br /> /VO or & d4%11-anY c(oSer 7`h0.1-j e.yisfin <br /> ql DY et rile/1 r, �3 e r1 ee <br /> r i1 11aoa€. D/44 tO & 614,111-itectib <br /> 4-- • G tailer5 It' faity <br /> De, e Y . 'f"d -, Fee Rec: 00.6° <br /> v Id a y 1 n Cil k0. IN �– St 264 a� <br /> • Qa d C e Check#: 3)T y 7 <br /> /� 5Z• Wit- <br /> Date of staff site visit: �ey690 1C1 Initia of site visit staff: I <br /> I z ' <br /> APPROVED BY LAND SERVICES OFFICI-, ' . , ' DATE: 5^e; P1'.aQ w <br /> nilia <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '1'' w w rn 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 N 0 <br /> D o <br /> 4 o' <br /> r CD C IV <br /> cz <br /> Transcendent: Page 1 of 4 A w'` u 4 <br /> Laserfische: - Burnett County, WI Land Use Application–Rev 1/2019 <br /> z <br />