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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line o' . o <br /> n. ' <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure ;� <br /> $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �.,, O <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 N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ,�; <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> I <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. o <br /> o C <br /> Property Owner's Name: actv....31.. A ' ;,-,` JCALw‹,B .f, <br /> o II <br /> Property Owner's Mailing Address: ky Qcx.-wr/Ai< CO (A. -1), bjtr,. 1/4:1-T S/jU . • <br /> City 3 State Zip 7* v) <br /> Property Site Address: ,*(A74.--12_ . 4 t <br /> c <br /> Contact's Telephone Number: /7/S ,ile(o, '73 i l Iv 0 /7/ ";si, - . e, . o <br /> Contact's Email: �, rtv.r (q (� ,CS� <br /> d <br /> Legal Description of Property: 0 1-1(4,D 4o i D U o <br /> rio <br /> Section#: a(-J- Town#: 40 W N Range#: girl W Town of: h tw•. <br /> 0-0 <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): csot.' CLecvh 76) CA c4 <br /> Proposed Use of Structure/Addition: A(Qot'Tis#. -ro Ad ees ,c S 14 erla e.A. o I <br /> Anticipated Start Date: y ig-Mt> 0 (Home/Cabin;Commercial Business; edroom;Deck;etc.) g C7 <br /> ` <br /> Building Contractor: ' k rkC •ct QQ l tee U rn IV Sewer Installer: i,f,/+ C �j <br /> v‘ <br /> AREA BELOW THIS LINE FOR LAND SER ICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> xJ <br /> x Fee Rec:/5-a-9- <br /> Check#: S <br /> Date of staff site visit: ( /11'7!)C)67)-° Initials of site visit staff: d <br /> a <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: x-15 J c -D 'zi <br /> CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT . Wg' Wilro <br /> APPLICATION IN PLAIN SIGHT � �g � CS^^?� <br /> Transcendent: - uuu <br /> Laserfische: Page 1 of 4 ' v o oa <br /> Burnett County, WI Land Use Application — Rev 1/2020 .1 o Q <br /> d <br /> gffii <br /> cn CD <br /> I r-------71 <br />