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c-/ LAND USE PERMIT APPLICATION — Burnett County, WI ac <br /> b <br /> Applicant Complete All Sections Below This Line 3" CD o <br /> C,. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Nt Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � O <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 "D, E <br /> _ G7-ssory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ..-_ <br /> �� <br /> �� <br /> Ia�,7Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> y • ,eways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 -r= <br /> o 011 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w E <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- -. <br /> 0 <br /> �y f j� 1 z <br /> Property Owner's Name: ';;<Pk 0 f (d ; f'''1ll') I A .�; I flkle �, <br /> q'40 C C c R6 A4 4 iklj 0; _ 1.183() r.,-. <br /> V ,--_,, <br /> Property Owner's Mailing Address: / <br /> /� p r � <br /> Property Site Address: 50 v t !�/6 6 i City kLI �$gate ;(/3�` v ^V <br /> Q C (� Z o N 1%1r ' <br /> Contact's Telephone Number: 3 ..()L-(i 0 ;77 p C k 7 j5"-$gyp(3, `��-c 3 d <br /> Contact's Email: (" (� ��� d , <br /> c L IJ[�i 6 6,4„„„,, .c 0,,1'1CD 1 <br /> Legal Description of Property: 0 oc <br /> Section#:.,-)4 Town#: A/) N Range#: I W Town of:S LV I S 5 0 <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): a t:`t ®o v, <br /> Proposed Use of Structure/Addition: Ho At `' l i /. o x <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> = <br /> Building Contractor: Sewer Installer:O p< / N kt () T.j <br /> i ,‘ - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <br /> z v <br /> H Fee Rec:6a66° <br /> 66° <br /> U Check#: t"7(O <br /> C <br /> Date of staff site visit: 13/ 0 In' ' is of site visit staff: iR n <br /> z <br /> c <br /> APPROVED BY LAND SERVICES OFFICIP"---"----------11ATE: <br /> 5 /11(30. ../) � <br /> Q. T ffi <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 <br /> D n 0 <br /> IMI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo <br /> Transcendent: - Page 1 of 4 x � <br /> § o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 <br /> co <br /> f <br /> L J J <br />