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LAND USE PERMIT APPLICATION—Burnett County,WI c C <br /> b <br /> Applicant Complete All Sections Below This Line 5- c <br /> a ' <br /> Permit Types and Fees:(Please,check appropriateboxes) d <br /> X, Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,RO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 co <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> lz <br /> Dedc/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Q U. <br /> Driveways)&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 -: <br /> filling/Grading $150 Boathouse $500c Mi. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 n <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. .9 <br /> *items not listed above will be treated as accessory structures,such as: o <br /> pergolas,landscaping,etc <br /> Property Owner's Name: 1'(A i I o <br /> E. • <br /> S <br /> ��t2�Yt� � � NW I CA v P4 t 1167— <br /> Property Owner's Mailing Address: ?Q �j 0'. ( J WC b si-er WI _9 (3 g G <br /> Property Site Address: ca-)3�I3 W t CO fl C\0 f‘S L c\e Cy,ity State Zip 5 E <br /> Contact's Telephone Number: La\ejr 7+rS 5_56 .•��I3sr - <br /> �!! ° Q SP <br /> Contact's Email: CA. 1-L\-erv,or1 n <br /> i 1 � l?, \O . Cd tY\ ct <br /> o <br /> :% <br /> Legal Description of Property: Lok a CSC\ .. 71 LS V .. <br /> 's N "ct <br /> 0 00 RI <br /> Section#: 3S Town#: !-10 N Range#: /4 W Town of: Oc' \c.nd _ <br /> ao <br /> *Attach additional page f needed for lengthy description OR attach a copyof the deed OR attach taxsystem roe t7 <br /> property nYPage•s <br /> Tax ID#(1-5 digit number;found on tax statement): Lill yet <br /> CA <br /> Proposed Use of Structure/Addition:_V n HO rv�e• y 3 <br /> —-� <br /> Anticipated Start Date: F x <br /> (Home/Cabin;Commercial Business:Bedroom Deck;etc.) <br /> is <br /> Building Contractor r o ir\ CO S't'• Sewer Installer. k r Gni -3 <br /> �UfI ` �1 t� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY JJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> x 1 <br /> AFee Rec: 00 — <br /> h y Check#: Zo� <br /> Date of staffsite visit: l / • i of site visit staff: �/ o <br /> R <br /> APPROVED BY LAND SERVICES OFFI • . ----- 6ATE: z <br /> UPON APPROVAL: APPLICANT MUST POSTCOPY OF [77 <br /> y nNO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -43 ©' <br /> O ® utill <br /> CG <br /> Transcendent: - -< v c° rt.,1 of 4 o Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 < . <br /> .' <br /> G <br /> NO <br /> cnD <br /> v <br /> I <br />