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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' o <br /> pp p rD , <br /> n. <br /> A ey [-- <br /> Permit Types and Fees:(Please,check appropriate boxes) w a\ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "v <br /> �O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Cr <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ` <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 F ms` <br /> C2 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- V ,k' <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 r k <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. -k <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. b 11 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-- <br /> 0 <br /> • <br /> Property Owner's Name: /V C?t'- {x(Ive c:-1Ptscl q -- �i ve vS 1i2 1' Mark T1(I r o �, <br /> --II <br /> Property Owner's Maili • A.•ress: 7 vi 7 Al.. 6&i$5 [- ke. Roe. L+JQ 1 54,r- GST 5`' 13 3 <br /> ,_ !� ` City State Zip P. <br /> Property Site Address: '.1" f'l e l/ft e_ R oC , f r 5-kr w l cryg 1'3 '' <br /> Contact's Telephone Number: 7/5- 1/1 I 6(D 9 0 . a s� <br /> o <br /> Contact's Email: Ma r e @ 62 (Nr i� , Dr c <br /> Legal Description ofPro e J E NE. LVCS< or N b <br /> p p rty: T ` l�f C71 3 J� X LA S . <br /> Section#: 19 Town#: • 3 '7 N Range#: (c, W Town of: /1/t P e_h n.'vL� aq <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): // 5 g LI ci, <br /> Proposed Use of Structure/Addition: lcJnrIc s ti 6? - t.4 . woh:4 UvLrkrA0 eic _ <br /> Anticipated Start Date: /vl c,y %,ik 2.0 2 6 (Home/Cabin;Commercial Business;Bedroo771;Deck;etc.) ° p <br /> Building Contractor: ea n rf, H?d r r C k Sewer Installer: — y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c.!)THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW• <br /> NJ 6A— \-6 ?--- 14 uvrYvk v-\ 14-0,6 r -\-ic,Ni z <br /> H Fee Rec:l5(-7 <br /> Date of staff site visit: 1 <br /> Check#: <br /> a d4°5.--- <br /> 01-° Initials of/Ate visit staff: li\W n <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE'—itlikda-C) u, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ;:rNI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �,w Wa=z 0 <br /> NI <br /> Transcendent: Page 1 of 4 °C N o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 co Q <br /> ' 3 OE <br /> a <br />