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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line CD o <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> CD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 cPo <br /> Accessory Structure(Commercial/Industrial($200 Addition/Alteration to Bunkhouse $150 G� <br /> tar <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 p <br /> Filling/Grading $150 Boathouse $500 • <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 m IL <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 3 J - <br /> Property Owner's Name: 2/0 nQlet -t 1't Pr teeit 76 fit/P e5 _ <br /> Property Owner's Mailing Address: -5-93 5 oU S ST 'S MO S-563 / b <br /> /� City State Zip <br /> J <br /> Property Site Address: 4.s© It 7 ZA/ l/i.e i-) l ted. 5t`4`' (Me eel o.ti f-W s,p\ <br /> U < y . . <br /> Contact's Telephone Number: 4s-/ - , .-_,5--? — L'/2-0 2 667- 210- /z. , <br /> ij <br /> Contact's Email: , s m • c a'K Li �s, C� a : <br /> Legal Description of Property: ohtc- NiQ 617-0-r /1 s 5,e ,j' cee- /l ,(,44 i'.- 5OQ <br /> Section#:1- y Town#: N Range#: /(o W Town of: /V(�ep(lon/ o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q' <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: 5C ret rt pc reit a- c Pe n- deck <br /> 4 p + <br /> Anticipated Start Date: ,-$ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) p <br /> Building Contractor: 5e/f - Sewer Installer: N A -- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: y�y <br /> • Qcr- V-Oc- Sc re:e IA po c CAI cl, r o QA5 Ions +/o c k 1\ z <br /> p tJ 5 b PA ii4-ea - - 00,,►\ <br /> H Fee Rec:�=xao`P <br /> • Check#: ?.O/59 <br /> E3Date of staff site visit:4 )-(31 In' ials of site visit staff: k\c___ rria <br /> Z <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: ` e °i . m 1-7 `cjJ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFun a 511 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z.m N <br /> Transcendent: - th o <br /> Page 1 of 4 '2 r <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 r `< <br /> de TR <br /> cA <br /> LTJ <br />