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LAND USE PERMIT APPLICATION— Burnett County, WI c <br /> < b <br /> Applicant Complete All Sections Below This Line 0 cn CD o <br /> a <br /> Pt:rmit Types and Fees:(Please,check appropriate boxes) f--:•3 <br /> ::� �1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cn <br /> /Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 _ <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o O w <br /> cDF <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 , 6- <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 r <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. II <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. C.. g <br /> 0 0 <br /> • <br /> Property Owner's Name: J ei- C_,r)(ph n cx, y_,Ort <br /> Property Owner's Mailing Address: ) tD 1/ 775- (�P r^ •Rd r t't C4'/P jw/v� b <br /> 7 <br /> at City State Zip = cn <br /> Property Site Address:otci 8'6 Q0_/( /e RJ.. Cc.h.L4e; l-on <br /> o o <br /> Contact's Telephone Number: 6/:,), 390- ems- Z 4. <br /> O -e <br /> Contact's Email: in_do ri rt a I/6 r2 ecyfra i I • 0,0 y".._ <br /> Legal Description of Property: 0,4 d±,j C.S)l1 V o l 6, pan e 2e 0S' i n g Uv, 1 <br /> Section#: Town#: 1/0 `"N Range#: / 7 W Town of: O1-1- C/ go <br /> P. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> Tax ID#(1-5 digit number;found on tax statement): / kJ 0 - 1 c4 <br /> H H <br /> Proposed Use of Structure/Addition: �a(-ace' e- ��.�-X.3i <br /> Anticipated Start Date: 4 1 e , p?,Cj (Home/Ca n;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: 4 t- nS u re ;,.4 kcv 6-) Sewer Installer: i-e n e H <br /> /' <br /> 00 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: k O <br /> X01 \aw km€‘AA 01 z <br /> H Fee Rec:?(5 060 <br /> x <br /> Check#: cP0$4 <br /> Li d <br /> Date of staff site visit: ,5' 4 °X Initis. f site visit staff: "_ ____ --- <br /> APPROVED BY LAND SERVICES OFFICIAL: L i • TE:L5 / .„' <br /> ,.I <br /> a .... <br /> .r.. 1,, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ` p <br /> SIGNED PERMIT APPLICATION IN PLAIN.2- i <br /> • o i; <br /> "T S. ' <br /> Transcendent: - Page 1 of 4 d, 3 Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020t,11 '"�`� _ A <br />