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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' o <br /> � <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Z <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 O <br /> til Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W a' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 C) ...-4Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r �' <br /> Filling/Grading $150 Boathouse $500 , <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 c4 .,"11-- <br /> C.__ <br /> * <br /> C— <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a d <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. 5. <br /> 0 <br /> 0 n <br /> v <br /> Property Owner's Name: crer y !J. MCvQ aAC � Cvl) $CCNU r f / ` <br /> � <br /> Property Owner's Mailing Address: .36io Violet C i �C1e &OcA.At5 h <br /> tk r q; W1 14e4 G i' 3 <br /> city, State Zip ''' c <br /> Property Site Address: 13 i I i s t r D.ill R o tX.0( Cr r ant 5 b r 9 WI -548'46 <br /> oN <br /> Contact's Telephone Number: 115- 4'3 I -- 0 4?0 „ <br /> C7 <br /> Contact's Email: yt\CAai lyj (� gfA.rk'� StDitl• lteICDrA. t1e,l¢ co <br /> Legal Description of Property: WE. NE + <br /> Section#: S 14 Town#: i N Range#: I q W Town of: We, s t MIA,0 6 J � fx A. <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number;found on tax statement): aZ $0 9 (o c, <br /> Proposed Use of Structure/Addition: S' t 0 (' A1 e She t� i x <br /> Anticipated Start Date: `b /I/a 0.O (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: RS CoA 5 t f'uc t i oA Sewer Installer: N A y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTSICONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <br /> 06-\-- €0 U Y\ los- �;6 pzi <br /> z <br /> Fee Rec: 150 <br /> x <br /> N(__-- Check#: -](`f(�P <br /> Date of staff site visit v Initial of site visit staff: <br /> o 8 <br /> l <br /> APPROVED BY LAND SERVICES OFFICIAL: GATE: /i 3/ A <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W <br /> coig <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o n <br /> I;Transcendent: - Page 1 of 4 ^^mac.,' Q <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 Z huh <br />