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LAND USE PERMIT APPLICATION-Burnett County, WI k g b <br /> Applicant Complete All Sections Below This Line cri, o <br /> a <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 s.`�O <br /> F <br /> XAccessory Structure(Garage,Shed,etc.) $150 • Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 p <br /> C N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° C <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 7- ' ) lb <br /> o b <br /> Filling/Grading $150 Boathouse $500 l <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 `" <br /> 11 <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- g <br /> Property Owner's Name: n9Nik Uj) 05 6--V/G7 - 2 <br /> '/ 'A -n IL <br /> Property Owner's Mailing Address// 7a g''3•, TI., A Neel Gprif� .I' � 5536 t `�' <br /> 9'5-- <br /> .� / C City / Stde Zip E <br /> Property Site Address: L'a ' V G. �2--/ / D . 7171E4-4- LA fes' / t/ a`1 is }-/ 3 <br /> o <br /> Contact's Telephone Number: n. <br /> �s <br /> Contact's Email: 0 9 ye4 t7,-62),. ro <br /> Legal Description of Property: Lai- 9. Ce5 ,, I/ AD Gvv l 42 <br /> 5 " 3) a <br /> � <br /> 0. <br /> Section#: ,c• 10 Town#: I N Range#:7 3q AAv Town of: t- - ,(L-&- <br /> v <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): I ‘ 7 E„ <br /> Proposed Use of Structure/Additi c n: 6 / —y /` F x <br /> Anticipated Start Date: it/AJ .L7 p1,Q COHome ommercial Business;Bedroom;Deck;etc.) = p <br /> Building Contractor: Z• r Sewer Installer: • <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS 1.,ISTED BELOW: .„o► <br /> tiA-- "- -"Of k prtopI <br /> -4 Fee Rec: 15023 <br /> y Check#: I Lew <br /> Date of staff site visit: / 0/ In teals of site visit staff: <br /> z <br /> IJ <br /> v <br /> APPROVED BY LAND SERVICES OFFICIO: "DA`PE- � ) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m <br /> GI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> r 2 3 <br /> Transcendent: ilifil <br /> y <br /> Page 1 of 4 v o0 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 <br />