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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> un u N <br /> Applicant Complete All Sections Below This Line 5. e <br /> CI. <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 R <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "\ 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(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 r D' Ili <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100_ Permit Extension(1 Year Extension-Allowed Once) $100 b <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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. o g. <br /> Property Owner's Name: � 6 0 o g..g....4- t �ti.. v N <br /> 1 -1-"c 1,--cl -n P <br /> � kI • <br /> o <br /> Property Owner's Mailing Address: k46‘6 460-a Ael q P.-,.:114,-1,s 0 ,bets,, W� 5'X130 <br /> City Q State Zip = n„ <br /> Property Site Address: LA ix1 L c J e elm- a`' `"r E <br /> o r <br /> A.Contact's Telephone Number: CV'-. 1—'1) 1 ' 011 a <br /> CI <br /> Contact's Email: AL`saSTA''-e_ an, A -0j_ ` Ws, <br /> Legal Description of Property: C]ti at1n-P rk Or()0 ‘,1-0 44-n- v-v <br /> C, . .J +.- <br /> %t-- •P‘vG <^C3`-c" $1 o u4 <br /> Section#: itl Town#: 4 N Range#: I W Town of: J A C.14.-52,� <br /> Sac <br /> c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* n <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): (;r.-r cn <br /> Proposed Use of Stricture/Addition: C3`A Nk Cs-ts E x <br /> Anticipated Start Date: a u e*5 if V'5 'W lit" (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor: A!4 CLAnre?0 4 ti 4G ti-s Sewer Installer: - -1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -IAW <br /> it 5ight 616+1444, sma Ix serviced it -Mis LRP 40 be vat4, z ft <br /> /V0 kalotfaR t '6 adovied ilk. POP'S et • 1 <br /> id 64X4Cie Kaktlit Mart Oft sahback ec•VAirtimiL43 <br /> Clit ivt0/102_bFee Rec:1Check#:Date of staff site visit: 5 isInitials of site visit staff: <br /> (((( / d <br /> APPROVED BY LAND SERVICES OFFICIAL i ' r —.A.A.. 'ATE: 'yam//9/2,,02.. r <br /> UPON APPROVAL: APPLICA MUST POST COPY OF co <br /> G <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° y , <br /> Transcendent: - Page 1 of 4 ii 34 M <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020rr, t o 0 <br /> cn <br /> D <br />