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LAND USE PERMIT APPLICATION— Burnett County, WI � b
<br /> Applicant Complete All Sections Below This Line a y i..)° . o
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<br /> Permit Types and Fees:(Please,check appropriate boxes) :IT j�
<br /> vDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure
<br /> $200
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `..N., O
<br /> Accessory Structure(Garage,Shed,etc.) X51 Addition/Alteration to Accessory Structure $150 CJ g
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 = ~oi
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<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r:.
<br /> Filling/Grading $500
<br /> g g $150 Boathouse
<br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 m
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<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee.
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<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees.
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc o
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<br /> Property Owner's Name: ,,3,a.-� i . �•- &.9fe.3 _ o- 1$
<br /> Property Owner's Mailing Address: /d / / l LM6-1.i%-u3 Mrd
<br /> fr Qom, City State Zip f.
<br /> Property Site Address: '41 J `7 g 7.-(4, fLC ,. , cam,, _7 5 'c E
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<br /> Contact's Telephone Number: LS) -- CfC�, - - j,Q,1 n.
<br /> Contact's Email: do Act 1,1, rs t,, .,r3„ G' CA,,,`GJt. 4e tpo
<br /> Legal Description of Property: S'r C�' / a lo ? Pct._r1 P' 6-e, t_ i - i(Lt,r-2-.
<br /> Section#: (`n Town#: in, N Range#: /'-t W Town of: 5.e..6 7-r-
<br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.*
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<br /> Tax ID#(1-5 digit number.found on tax statement): / 787S— in
<br /> Proposed Use of Structure/Addition: ,5 0.4--(4.-.1 .5',14
<br /> Anticipated Start Date: MA-'/,2S),;t{?,J O (Home/Cabin,Commercial Business;Bedroom;Deck;etc.) 1
<br /> Building Contractor:, ;, Li ►,,,.5. Sewer Installer: N,l--
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
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<br /> Fee Rec: 16-10
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<br /> Check#: loU9 \\)\of staff site visit:1-4 • Initials of site visit staff:
<br /> APPROVED BY LAND SERVICES OFFICIAL:W DATE: i.1, °0 1193(7
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF U nIfiiii
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - 5 ' +v
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<br /> Transcendent: - Page 1 of 4ro . f4
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<br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 c
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