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LAND USE PERMIT APPLICATION—Burnett County, WI c r <br /> 0 <br /> Applicant�Com�lefeSAll,Sechons. elow This Line c o <br /> -,,b:: <br /> c. <br /> Permit Types and Fees:(Please,check appropriate boxes)! o h <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "v ` <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 .x3.\ i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 W <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - <br /> Driveways/&Campground Structures "$125 WI State Statute 59.692(1v)Structures $350 r. e . <br /> Filling/Grading $150 Boathouse $500 o i <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 iv <br /> *NOTE:After-the-fact permits(permit aquired after construction has begs)may cost up to three times the normal fee. r <br /> *Communication Towers&Signs require a different application form;see corPe Q ding application,and fees. ro <br /> *Items not listed above will be treated-- as accessory structures,such as:pergolas,landscaping,etc. r 2 r <br /> Property Owner's Name:&faC1 �d-1( � z <br /> Property Owner's Mailing Address: IS* Ila v-L. Sci- /t/W' ,41,iJ , f J/W S5U(4o <br /> ,� /I City State Zip z rn„ <br /> Property Site Address: JIOt( 61Ackb w� I�d Sr,od- - Ty G�� <br /> Contact's Telephone Number: 7 e g <br /> p ��•Z 7�U 7�y/ a <br /> r I a <br /> Contact's Email: 6✓4 (. 4L5*17 A-,j c 0 k d <br /> Legal Description of Property:tad Z G.S j v16 pas e./i<6 firiEov !ad- 617 5,,,,,,A3,cf 3,c/dr.,go' I KN <br /> Section#: 3L Town#: tr0 N Range#: /C( W Town of: SGv��" d <br /> t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1.3 <br /> Tax ID#(1-5 digit number;found on tax statement): f p0 iS <br /> cn <br /> Proposed Use of Structure/Addition: Co-GJ i" a <br /> x <br /> Anticipated Start Date: rift (Home/Cabin;Commercial Business;Bedroom;Deck;Letc.) j <br /> Building Contractor:/ladrr /'o.l,(l l-t e-- Sewer Installer: (,tJ I kzEr L 01 it JpbL '-' c , <br /> AREA BELOW TlIIS LINE(FOR LAND ERVICES STAFF.COMMENTS/CONDITIONS ONLY p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 4 <br /> - ci(' , �(-5 Pecm;'r � JcienIStaoDot 0` <br /> • kptli <br /> cz <br /> Fee Rec:300--- <br /> S i i i a-oao k\y ;c.; Check#: I-7941 <br /> Date of staff site visit: Initials of site visit staff: r.' <br /> v. <br /> APPROVED BY LAND SERVICES OFFICIAL:(\ILS\ ATE: S , !� `":) <br /> • ,til <br /> UPON,APPROVAL. APYPLICA T:MUST P 6:1. O0 9 ,_J F l r UM <br /> y D <br /> SI°,.r NED PERMiT hP vLICA7 �'.I.� IN,PLAIN SIGHT 3 <br /> tg, gi cp w P <br /> Transcendent: - <br /> Page l of 4 >+: y n e <br /> , g c Q <br /> Laserfische: Burnett County, WI Land Use Application—Rev 1/2020 tri, fD,Z <br /> n <br /> Eiji <br /> ' Lam.- 73 <br /> 1 <br />