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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `'[` �` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 " C <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '� O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 $' R r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- G <br /> Filling/Grading $150 Boathouse $500 ,c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 V <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 3 1 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- g 1 • <br /> 0 <br /> Z fig <br /> Property Owner's Name: 'BO Ah L ,s ',I-U KY) <br /> Property Owner's Mailing Address: a 8016 Lon c r /t c 2d ilti eb '/rr idyl 3N893 4 <br /> City State Zip 5 rn„ <br /> Property Site Address: 6S 6,12 e 3 <br /> G <br /> Contact's Telephone Number: 7/5-- g E 6 - 7 / o n <br /> l / (`� G 4 e <br /> �/ <br /> Contact's Email: 7 Cal)La W Lake h c,rn ' �ice c ` t77 Ctt L i Corn co <br /> =' <br /> Legal Description of Property: o rro <br /> Section#: 2 0 Town#: 110 N Range#: /6 W Town of: 0 A KI, RN 1 <br /> a. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> n <br /> Tax ID#(1-5 digit number;found on tax statement): / 416-6 v, <br /> p S �erC� e shed 2y x 3C '�, <br /> Proposed Use of Structure/Addition: ; <br /> Anticipated Start Date: 1/1- vate'e?i S ('Ome,/Cabin:Commercial Business:Bedroom:Deck:etc.) C <br /> a -i I <br /> Building Contractor: ,J x115,5 C'2 ,S' 4[C Sewer Installer: //p 0 e <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • cRt Ve- 5'+ ed ckceo, ln$e S t t.th. 4bcAlootek-14'r\ x - 1 <br /> 0-- --- 511,ect pernv tte4 <br /> -, Fee Rec: 6, -1 CP <br /> x <br /> Check#: 57 <br /> /�� , tA,12.______ F,,,-,^ <br /> Date of staff site visit: Initials of site visit staff: <br /> - i I <br /> APPROVED BY LAND SERVICES OFFICIA TE: 3/Pw <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,; 2 - a, ( i <br /> Transcendent: - Page 1 of 4i'� Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 r <br /> 4 <br /> LTJ <br />