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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> 's b <br /> Applicant Complete All Sections Below This Line CD o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d — <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 oF <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 ° C <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r- <br /> Filling/Grading $150 Boathouse $500 g <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 `n <br /> a <br /> a <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. ET <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pe galas,landscaping,etc. o 7 <br /> Property Owner's Name: C 0 la' \ , X/ <br /> o C7 <br /> Property Owner's Mailing Address: CV 4 t I / Di (2 )J 6 fJ_ 5yc, 0 <br /> y1,, � State Zip a ' <br /> Property Site Address: 0-1 � � (�� <br /> C�� ( T--1. 1 � <br /> . 0,-,„--74- ���7f < <br /> � <br /> Contact's Telephone Number: ) c� 3 — 6o(4.0oo. <br /> Contact's Email: n <br /> 1 COIL <br /> Legal Description of Property: A -e m . /I. , • - _ <br /> Section#: _Town#: )J N Range#4/4:____W Town of: De. y r, r da4 <br /> oa <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 3 S O <br /> o m <br /> Proposed Use of Structure/Ad.ition: 0)71 Q„ x <br /> Anticipated Start Date: A - *—_ A (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> r <br /> Building Contractor 0.vhr�/(J -q,1' ai.) - [?yyt,�$ Sewer Installer: ,)- r/ bliStiftif)J, --- <br /> ( <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ( • <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z (p SY <br /> iliW V <br /> --, Fee Rec: 2 t7' <br /> ^�� v Check#: ZOO(( <br /> Date of staff site visit:��� 7'...04'd <br /> f/ / ��" 0 Initials o site visit staff: r <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: r�l-Zi < j <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFa D (tilt <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 0 <br /> Iiiiii <br /> Transcendent: - Page 1 of 4 x m cc c' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 < 4 <br /> gin <br /> 3 <br /> z <br />