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LAND USE PERMIT APPLICATION—Burnett County, WI cr r <br /> Applicant Complete All Sections Below This Line o c o <br /> ,* ." ; pi, <br /> "ermit Types and Fees:(Please,check appropriate boxes) d <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 /> r\ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 V'` ;i <br /> Accessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 G" <br /> y Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> \ Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S ZUJ <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w ). <br /> a <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. <br /> co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r 9 O <br /> F O O _ i <br /> Property Owner's Name:! $ V =' I C( 1 i t J �1( 1��� �1 t� s, N <br /> a 5 � \ - art. I� s 5'i(9 ° ,,,- <br /> Property Owner's Mailing Address: <br /> '+ City „are Zip . E„ v 0� <br /> Property Site Address:;2`1 id G ('i,..�' t I Oat e ' / <br /> 7 Q y '\ <br /> Contact's Telephone Number: 1 5 3 09 r,-`1 a. a <br /> Contact's Email:RI,c C.�,(j j,Q(6 p. Co In o <br /> JJ Dri- <br /> Legal Description of Property: 1 �I► } 0' it5 .. 0q) tJ •,:, ; <br /> Section#:3 3 Town#: 3`1 N Range#: ICO W Town of: kee.n otx d n <br /> 4ttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 3. <br /> Tax ID#(1-5 digit number;found on tax statement): I s�., L,7 22 12 cn <br /> Proposed Use of Structure/Addition: CAO I I -_ 0/e (i '; <br /> Anticipated Start Date: S. /--,20.2 (Home/Cabin;Commercial Busin ss-Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: ptDI Z\il S \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> v>, <br /> - Fee Rec: — <br /> Check#:i5 ., <br /> Date of staff site visit: � / 41;1) Ini 'als of site visit staff: IA Y '63 <br /> Pi <br /> APPROVED BY LAND SERVICES OFFICI ViNkTE: S <br /> fi <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y a a <br /> � <br /> r 117 CS <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 d o g <br /> ". so <br /> Transcendent: - Page 1 of 4 g 11 1 C <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 n m <br /> . <br /> i <br />