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LAND USE PERMIT APPLICATION—Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 0c <br /> co <br /> n. 1 <br /> r <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 u <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 's.f� , <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 /> � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures ,$350 ' <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <br /> R. <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. �o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r ,k <br /> z <br /> Property Owner's Name:r e. A e E . — ` - , A L ° <br /> Property Owner's Mailing Address: S/69 Pa r 7 --71; Oarlba , -175983. 1— <br /> PropertySite <br /> 1 <br /> C _ Sl fJtate Zip 5 G <br /> Address: p/6 9 far r c -- 10a i'jh(,i r y (.C,�,1._ .� V J '' Q <br /> Contact's Telephone Number: 14,c-5 5 ! - 0 8 9 0 n <br /> Contact's Email: •Ori re.ri E�? 4) Yc.,ioo, eQ K \ <br /> r /15y1SLakShar 0: VissiGA-t 01 <br /> Legal Description of Property:y �� '� e <br /> am/tow L(fr.P_ 40 r3 d.971 V %O P /0 8o ro <br /> Section#: Town#: N Range#: W Town of: 6 0 k/a%'l ag <br /> •go <br /> i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertyPa page.* <br /> Tax ID#(1-5 digit number;found on tax sta ement): / ' 6 t 6 <br /> Proposed Use of Structure/Addition: OM I0 <br /> Y <br /> Anticipated Start Date:5--a 6- 0 (Home/Cabin;CC mmercial Business;Bedroom;Deck:etc.) p <br /> Building Contractor: 1ewer(Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> z <br /> I <br /> x Fee Rec: It) <br /> Check#: I4 07? <br /> Date of staff site visit:�c; .:01.0 <br /> dor , Ini '• s of site visit staff: <br /> rn <br /> APPROVED BY LAND SERVICES OFFICI , DATE: 3---23`"PCJ . _..,.,c__ J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ri a m. Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT L' c 2 w (��' <br /> -< O • C7 <br /> Transcendent: - Page 1 of 4 rn $ <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 < g�� " <br /> 0 <br />