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LAND USE PERMIT APPLICATION-Burnett County, WI a 0 <br /> • Applicant Complete All Sections Below This Line 5 c o <br /> co I <br /> 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Vw <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W EO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r.. <br /> ) a ' <br /> Property Owner's Name: _ /'. L 1 O S/ 0/ z° <br /> *11 <br /> Property Owner's Mailing Address: ' L? ( Y6)rk 11kRt. S t, Pu I011\15-706 ..S is, <br /> City State Zip <br /> Property Site Address: E <br /> kiZ...) C <br /> Contact's Telephone Number: 6357 — 7 7 17— 1/1/75CD <br /> 1 <br /> 2 \O' _.05Vo,4Qa, pp . CO <br /> Contact's Email: AM <br /> Legal Description of Property: C. J-1 Mi. (?---9 l 1 V C L, OV 1.o t- 3(t 0) o z iL.;)(b) <br /> s.Section#: \) L Town#: LC 0 N Range#: 1Town of: (Jr l©n CrC <br /> 7 t7 <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): r-2 Lf 702 Q <br /> Proposed Use of Structure/Addition: 1 Q 4— C3 CJS rQ e , —. k <br /> Anticipated Start Date: �—/ —a Ur a t) (Home/Cabf Commerci usiness;Bedroom;Deck;etc.)�`t _ C7 <br /> Building Contractor: j e Sewer Installer: ©p1 i n ' -, ,1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> o l .�o c c� 1c re SS 6 S�-tn� ll a-0 ao(coT..pieTe) z A , <br /> SPP Y � <br /> • iy\o.\t���\r� ©off kd @ s `� C S <br /> 0 0.\n*a\N 7 / 5e-f-/a G , .r'Ylorf�c r'N�'f <br /> n cin /1 �lJ ,� o <br /> e r(\,02-c\- , LI 0 S b c.(c -cry <br /> , FeeRe` G 630. <br /> /MrL <br /> r Check#: 10 3V <br /> e- <br /> Date of staff site visit: ♦�� • C_A Initials site visit staff: (11C1. � r <br /> z <br /> C C <br /> APPROVED BY LAND SERVICES OFFICI DATE: 3-.)`—,a0a0 e <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF E �c�Q-J <br /> Oak— <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z �\Drvv <br /> 's-k(fi, <br /> Transcendent: - PI�, <br /> Page 1 of 4 x <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 <br /> ci <br />