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` r , c *iij r <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line L'A0 c o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v„ .. <br /> Commercial/Industrial Structure Z 25----'$300 Addition/Alteration to Commercial/Industrial Structure $200 -..... 0 <br /> Accessory Structure(Garage,Shed,etc.) 5t1 Addition/Alteration to Accessory Structure $150ry 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 X� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C- a <br /> at <br /> Filling/Grading $150 Boathouse $500 <br /> IP <br /> Six Month Cam ' x_ .. ( c <br /> p�ngUr�+�(9pe Ptri4ear) $100 Permit Extension' arfesiau_Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal52 <br /> -- °''Corrimunicati0n Tower�"&i tgns require a different application form;see corresponding app ication, fees. ", <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- g c <br /> o -'• • <br /> Property Owner's Name: 5 l .S co-, v W i S.So r‘ z 1 <br /> Property Owner's Mailing Address: 4 U 5 0 5 pevIcce LA'e 2oc-01 Fred er i c W'L 54.631 i <br /> City State Zip B <br /> Property Site Address: Z A IA 'i <br /> o <br /> Contact's Telephone Number: (o t 2 - 2.34t - ZZ31 <br /> a <br /> Contact's Email: S J W So r (.5C, q✓►�a i , coves n ' <br /> Legal Description of Property: o of <br /> Section#: 22 Town#: $ 8 N Range#: \5 W Town of: L4otltk4-e, ag <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> a. <br /> Tax ID#(1-5 digit number;found on tax statement): 10014.1 cn <br /> Proposed Use of Structure/Addition: G u-,...ge U o X <br /> �J <br /> Anticipated Start Date: ‘3-'Ali j a 0 t(o (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) = E <br /> Building Contractor: <br /> 1...A <br /> Building Cov1S4v'u.dn'ar\ Sewer Installer: N/A <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 /> H Fee Rec: 6242 --- <br /> E;'-: <br /> Check#: 3 1 0 <br /> C <br /> Date of staff site visit: �a —��Initials of site visit staff: <br /> z • <br /> ---. '--"---:1/ c <br /> APPROVED BY LAND SERVICES OFFICI . - DATE: r'/l 3v0).. x r' <br /> m r <br /> < ' Uu6 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF > g t 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo fill <br /> Transcendent: Q <br /> Page 1 of 4 g� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 UJj <br /> n <br /> C <br /> c, <br /> z <br />