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• LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> y N <br /> Applicant Complete All Sections Below This Line 50 <br /> CD 1C. <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 -� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °C.: <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. L` <br /> Filling/Grading $150 Boathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension Allowed Once) $100 m <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. - Ng <br /> Ll <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ,-' 3 % <br /> Property Owner's Name: STe1 �'-" �C_�G ((Wl o P r <br /> Property Owner's Mailing Address:�'(�;h -1 ( . E. _Lko 8�a�- , R ���}c% 1- <br /> Ci State Zip =Es. rn„ <br /> 2gA193 1�1� ,1zte. Lr, �r�ced, �s-i t. E <br /> PropertySite Address: <br /> Contact's Telephone Number: ((j -.:D7cD-- � a k <br /> d <br /> Contact's Email: 7.3 )1.je c r-.t.c \ , (b 7 1 P. <br /> wAvswie 4/0 N c <br /> Legal Description of Property: LOT .544776g/If 1Z .IU 44 fy WIC N <br /> 0 .° <br /> Section#: Town#: LC) N Range#: 14 W Town of: , tc <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 74 <br /> Tax ID#(1-5 digit number;found on tax statement): 4-v-2003 a, <br /> Proposed Use of Structure/Addition: );/` ,4 D D/7? .-' 12_ xx 3U P j/is L . <br /> Anticipated Start Date: M4 Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) = p <br /> or <br /> Building Contractor: pW AJ Ii _ Sewer Installer: 14 A y <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 /> -, Fee Rec: c2D0 <br /> s <br /> FA <br /> Check#: 13 i 47 <br /> r—1 � o <br /> Date of staff site visit�4! 'L • <br /> / 1 of site visit staff: r- <br /> APPROVED BY LAND SERVICES OFFICI DATE:�j Y O rrrr <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1 <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> < O t1 <br /> Transcendent: Page 1 of 4 n -. �? <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 c -- <br />