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LAND USE PERMIT APPLICATION—Burnett County, WI cr b <br /> Applicant Complete All Sections Below This Line o' CD o <br /> CI. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> rD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ��\I <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 rt cc <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° t) <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> ,)L Filling/Grading $150 Boathouse $500 v--- <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 IDD <br /> U' <br /> *NOTE:After-the-fact permits(permit aquired 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. l <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - g <br /> 4796,Z <br /> o (3' <br /> Property Owner's Name: �si�c/C� f 6,4/z>"/ ti,vi.S F) <br /> F <br /> Property Owner's Mailing Address: .C.-42-5-9 �c/c.•,2c..,re' /ear Cc /s/e�� 'it) & Y � -O <br /> City State Zip a' <br /> Property Site Address: fA/7?G k' <br /> ov <br /> Contact's Telephone Number: �.�� - e /02 S�,Q'/ ' �J�02 c � a <br /> d <br /> Contact's Email:/0 4O0: . /k i J A- a 0 u 74`oa'- eCiorr cp <br /> Legal Description of Property: le,r/ {//3/ 8 '(4::,(//e/ 7Chvie �'r�‘.%/G'/p¢7 9 } oN o <br /> Section#: .23 Town#: die) N Range#: /,‘ W Town of: Ce...,1/°u.,z Dr 7‘01 g. <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-..77 c <br /> o <br /> m <br /> Proposed Use of Structure/Addition: %/ , <br /> Anticipated Start Date: ,`s/f`Ato (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -6 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t —3 ?,\,... <br /> c.1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -- Ff.' 1 Pet v'v' VIZ <br /> c V-" V-5 -Cla•v F4trkekk. 06A p 1aY1 z <br /> --- --titan dot 7; b-e p/acec( mo re tan �ee7` <br /> td-(a-c ° Fee Rec: it <br /> Check#: <br /> 5t� .,..._,_,___, .- <br /> j v) <br /> d 'Pay „..... <br /> •_ <br /> Date of staff site visit: Initials of sit vis' taff: q ---- - <br /> `_ t <br /> APPROVED BY LAND SERVICES OFFICIAL: ! 6 DATE: ✓ /3 i 17.76 ▪ i--_=_ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF I C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ ..&••• T <br /> r-' IV ...-.2 <br /> Transcendent: - Page 1 of 4 () ! o <br /> i <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 i.. ..�-- - - <br /> » -- <br /> d C <br /> a ,_ <br />