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LAND USE PERNIIT APPLICATION—Burnett County, WI `° r <br /> m i <br /> Applicant Complete All Sections Below This Line 8 <br /> O <br /> v <br /> Permit Types and Fees:(Please,check appropriate boxes) m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 e <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Q 1. <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 s• '--- <br /> Filling/Grading $150 Boathouse $503 '" <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 I' <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. .1 cJ— <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. S• <br /> I fJ f ..wri o p <br /> (� <br /> Property Owner's Name: t'"ccui •4 1o..� 1 t' C 0 0 <br /> Property Owner's Mailing Address: n -2-- S i t'- � k1' Tr 1 Ic .- <br /> City State Zip_ e. <br /> Property Site Address: e‘e2 E Ir,�t k Sect, �I-1- DA A o 1)c1►' I�j i S A o Ei' <br /> O ,o <br /> Contact's Telephone Number: 7 15 ' 7 3 3 - L (%S • s. <br /> p <br /> I .. <br /> Contact's Email: ?i ..ta WOK--0(08 C�Hai I I. CO PM K <br /> Legal Description of Property: 13 L I\C.K gE(4c 2 PtCRCS LOT 10 a °° <br /> Section#: 3(Q Town#: '¢I N Range#: 11 W Town of: c VI ISS I <br /> F. <br /> "Attach additional page f needed for lengthy description OR attach a copy of the deed OR attach tax system property page.• 5 <br /> 0 <br /> Tax ID#(1-5 digit number,found on tax statement): 22573 <br /> Proposed Use of Structure/Addition: S to 1-0,...5e, 1 <br /> Anticipated Start Date: 51'f/202o (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Ca <br /> Building Contractor: 1\10-14\S,&E._ 034ct. LIZ-, Sewer Installer: .3 Cn k <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0N <br /> Nol— fok •kiLksiv‘p,-,n t-k-c474-4cL--vtor•J z ,i) v4 <br /> po <br /> co <br /> Fee Rec. � <br /> Check#: 14-29 <br /> Date of staff site visit: Cj / KY...----'/ % WCof site visitstaff: <br /> CD <br /> APPROVED BY LAND SERVICES OFFIC ' 1 DA E U 4 /5°/?(`��- y <br /> ill <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF n-v <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 00 <br /> o c <br /> Transcendent: - Page 1 of 4 G Pa < <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 `' j.T. <br />