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, <br /> LAND USE PERMIT APPLICATION-Burnett County, WI g t-, <br /> Applicant Complete All Sections Below This Line c o <br /> ❑ a <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 <br /> U <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ ;I <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r , i <br /> Filling/Grading $150 Boathouse $500 0 .i C, <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 F <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. c <br /> Property Owner's Name: 6 e✓r Q . <br /> ( 3a <br /> Property Owner's Mailing Address: 2esz.7- 'caef Lt ck, ii4,, .. <br /> City State 4E' <br /> Property Site Address: 5 � ., E <br /> g. <br /> Contact's Telephone Number: 7l5 7-6)1 ! CSS G o • <br /> I, <br /> Contact's Email: C Piy((`�' cc cr to i . (,et d <br /> co <br /> Legal Description of Property: 4d n, <br /> Section#: z.4' Town#:Range#: / , W Town of: j s'n t7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 5. <br /> .....6 <br /> Tax ID#(1-5 digit number;found on tax statement): ,✓, <br /> 13 y� iE yt�r��t `t' l"/� <br /> 'tt'j [ cA o <br /> Proposed Use of Structure/Addition: eck�b� ©'t �- �& s <br /> Anticipated Start Date:spc,t 2,00.,.0 (Home/Cabi>f Commercial Business Bedroom; eck;etc.) a C7 <br /> I H <br /> Building Contractor: Y L(�et ieQ ( wer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY R �� <br /> THIS PERMIT IS SUBJECT TO ALL dCONDITIONS LISTED BELOW: th LI) <br /> 0- m81/4\. t o ( �c •r° _fe re r Q f ape 1--k1 o f aeC-S x <br /> \ Q <br /> ry\ctc-14e4 si•8e /o1- /I'r)e , 0— <br /> Fee Rec: -20092 <br /> y Check#: ^I.D4-/,3 <br /> � 1:7 ----' o <br /> Date of staff site visit: -7- doInitials of site visit staff: \i\c„ <br /> r- <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAML . / �� >c k Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CA a a <br /> RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> vo en iffil <br /> Transcendent: - Page 1 of 4m E <br /> Laserfische: Burnett County,WI Land Use Application—Rev 1/2020 '` G Q <br /> rfi om <br /> GEa =Z) <br /> 1 <br />