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LAND USE PERMIT APPLICATION—Burnett County, WI k b <br /> Applicant Complete All Sections Below This Line c o <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 L <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 <br /> A Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> 1:- <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. gq. G <br /> r <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. S • <br /> Property Owner's Name: 134771 SOR i;'I.ISErJ <br /> Property Owner's Mailing Address: VDi 9 et kf jyZgff i?P 5.1.• ge tryre 3 jWiv Seo a 0' <br /> City State Zip ii• �n„ <br /> Property Site Address: /6'6- C13135ON -TPS E <br /> O y <br /> Contact's Telephone Number: 65/—767-O 'Fc7 7 . <br /> a <br /> Pit 0 d <br /> Contact's Email:Or/.MaX0ri nekTCO.moill <br /> Legal Description of Property: o GV <br /> Section#: 13 Town#: Vo N Range#: %9 W Town of: cc rr v <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 5. <br /> n <br /> Tax ID#(1-5 digit number;found on tax statement): /7 qg I ' 1) <br /> 3- CA <br /> Proposed Use of Structure/A dt'tion: /24—c /C/,l1 v ' ' <br /> Anticipated Start Date: `/ j Z6 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d <br /> Building Contractor: pclco",3---7ucr,rt+nr Sewer Installer: <br /> 7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> —w <br /> a Fee Rec: `O') — <br /> x <br /> 1\1\R ,..___ Check#: IAN/Date of staff site v' : / / °/ C7I •' Is of site visit staff: 111 n <br /> APPROVED BY LAND SERVICES OFFICIA ` � <br /> DATE: 3 o[0o:G7 < <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF <br /> )::; 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT h N <br /> . liga <br /> Transcendent: - ? c.., o <br /> Page 1 of 4 4 N Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 c=. <br /> TN <br /> H LJI <br />