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LAND USE PERMIT APPLICATION-Burnett County,WI _ <br /> �: <br /> E N <br /> A:--.-,:--7----1.--,-------_-=-4-..--.:--,..:,,, 3elogr This Line b' Q <br /> • <br /> Permit Types and Fees:(Please,check appropriate boxes) III:� 0- <br /> Dwelling/Prindpal Structure $300 Addition/Alteration to Dwelling/Prindpal Structure $200 j <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 ro <br /> AccessoryStructure Commercial Industrial <br /> (Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse $150 � \ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C. <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> F. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ,5 (. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -0 <br /> *Items <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 'ro0 <br /> / ' r� o <br /> Property Owner's Name: (� v�l S ✓� .T; 0 <br /> R? r '�- <br /> 4 � ra <br /> Property Owner's Mailing Address: ,E�I- RY.z S ikvt � �".( ' •c <br /> � (� City State Zip n <br /> Property Site Address: a.%\pi i' ‘ fl e. I KAO 1 1 11.," .,‘2,. <br /> C <br /> ZContact's Telephone Number: 7f S 66-1 co <br /> Contact's Email: Q 11) s e.Y\c(Kr (Tc\. ej +a r- (,°t�r. RD/I-1g <br /> �` <br /> Legal Description of Property: � k '.\ .-t>tt.v'.4.e,S V /),- 5))- lel' 1>\ C1 X12 am'V r 1 b ao <br /> Section#: Town#: N Range#: W Town of: mac, <br /> r7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 5' <br /> Tax ID#(1-5 digit number found on tax statement): ‘. \\ 2 - t1)/0 <br /> Proposed Use of Structure/Addition: Lam,,1\ C e�l< / <br /> ,iO� VJ H <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) e <br /> Building Contractor: `� Sewer Installer: <br /> fl.,-:. W <br /> mtutuK <br /> L0WTBISZINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY e <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> o kCO r (IY1,�- o1-t CSC\ 9'��wt e.►v� 6)i �-1 i S--1i r z <br /> w <br /> O f -De- s \1 s w f\( t l';-eao <br /> • �a�dlfia\tri S f f --Prorl�') septi Ta pt . r Is (� <br /> G f i fl;c-.-I Fee Rec: 166 <br /> d' D <br /> / '�] t Check#: '211(s <br /> Date of staff site visit: L` �t2' ' c2 Initial of site visit staff: N\` <br /> ` i <br /> APPROVED BY LAND SERVICES OFFICIAL DATE:S/9 r'9:2-eD _e____�_� _____ <br /> a i-l'A A s z <br /> SIGNED-PERMIT—APPLICATION IN PLAIN-SNS R- ,,,,2 m zr3 lk--) <br /> i 4 70 <br /> Z.Transcendent: • i <br /> Page 1 of 4 !5 r.....) <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1t2020 1 i a o c=3. <br />