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LAND USE PERMIT APPLICATION — Burnett County, WI gg <br /> applicant Complete All Sections Below This Lind 0� CD o <br /> a <br /> ., �1 <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> X Dwelling/Principal Structure $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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 5 C-- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 e=. YO <br /> o ((�D <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v <br /> E <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. ro fin-- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> nzd t— <br /> Property Owner's Name: Se re ) \I aytd <br /> v t d Jodi r h e P <br /> p � j�,� �j p r t 1 L 8 l <br /> Property Owner's Mailing Address: 13(1)2,1 r.6 1 l2c1 H r�r ck-k, M v, ✓L-t, <br /> 4 0 c <br /> V City / State Zip e. <br /> Property Site Address: XX I� L 0-41 r- & S p 0 O1•1E�‘-- E <br /> Contact's Telephone Number: (Y I A - J(9( —I C)( 1 • a 1 <br /> Contact's Email: j XJ Oa I 2- q C) I • Ct)1 0 ro CI <br /> ! J <br /> Legal Description of Property: ge e— <br /> Cl C-�� eC1 00 <br /> Section#: 1 DTown#: 5q N Range#: II L4 W Town of: Ru 5 K— o <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 3. <br /> 2. <br /> Tax ID#(1-5 digit number;found on tax statement): 15 19 <br /> Proposed Use of Structure/Addition: Ho nil e/Cab( <br /> Anticipated Start Date: naw I t(-,, C,?0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) I C) <br /> �•-i (�i � ,LI-taller: <br /> �L � c VIIy <br /> Building Contractor:TM t'0 S N I UI��li l � `C �� �C eWe Instr: i IL/ ;i , 7C d , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY U01,LIe I CI) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _z v <br /> Fee Rec:300co <br /> V' Check#:[D7a, <br /> I� to <br /> Date of staff site visit: �� e ' fiats of site visit staff: )C-------- <br /> 2/ f <br /> I• 1 DATE: LF /6 c2e N1 <br /> APPROVED BY LAND SERVICES OFFICI ` � <br /> t <br /> -7. Nil <br /> UPON APPROVAL: APPLICANT MUS"1' POST COPY OF4 =Lit ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT "c N� <br /> r- Q <br /> Transcendent: - Page 1 of 4 N <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 LE_=J <br /> a <br />