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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line c <br /> _ <br /> permit Types (Please,check appropriated VJ <br /> and Fees: boxes) <br /> co <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 lT\ <br /> '41( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 io <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <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 $500 �' <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> a. <br /> *NOTE:After-the-fact permits(permit aqui red 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 /> co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S g <br /> z <br /> Property Owner's Name:5'1 c-ti-,e (4,- g'1(¢�- e e 1( S ° <br /> o \ <br /> Property Owner's Mailing Address: ?�(�6' Sky�ly�,j 904 Lie.“te,, ( .c(-4 s9 3 b <br /> CityState Zip B n E. <br /> Property Site Address: pCl /6,r . 54/.-j L., ap,,4 l,-) t.to5..2 L.). S y 6 c 3 E • <br /> o <br /> N <br /> Contact's Telephone Number: 6 i � — a Yo - s-8 7 L • <br /> a <br /> 2._ <br /> K Contact's Email: 5t-)e-i1-5 no -#�c e.�i til i -P, , L a u <br /> co <br /> Legal Description of Property: LoT Q 0911C .5 .',:y 1 q ti-- Ai MI <br /> Section#: Town#: N Range#: W Town of: (ro <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): 13 / 9 <br /> Proposed Use of Structure/Addition: rf /�R.,y f i <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Ar 4 0+-J ,. .. 0.175- Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> iNX,R(‘‘A <br /> iae 6st-ba45 -Profri <br /> :: !--- <br /> Fee Rec: ____ <br /> Check#: <br /> -�1 5 <br /> Date of staff site visit: C. I 9. Ini Is of site visit staff: U ` r <br /> APPROVED BY LAND SERVICES OFFICIA DATE: trl <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF f Iaga <br /> Cs <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTa ^? ifiiii <br /> 0 <br /> Transcendent: Page 1 of 4 ;;� N Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 ' <br />