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LAND USE PERMIT APPLICATION - Burnett County, WI V] <br /> r <br /> Applicant Complete All Sections Below This Line o' o <br /> CD I <br /> a. t�- <br /> A <br /> Permit Types and Fees:(Please,check appropriate boxes) d °O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> v"Accessory Structure(Garage,Shed,etc.) $150 _ Addition/Alteration to Accessory Structure $150 N n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o ADeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. J <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 F <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. i-• i p <br /> z -- <br /> Property Owner's Name: 11-IA!' Za�1;z5co .n C) <br /> Property Owner's Mailing Address: 17- ..1(i- � u <br /> .. - >v4 y% z:',.:, i- -' <br /> ,A L LCC- t <br /> C ,�r yzl`, ; -' 3 <br /> City State Zip z (1)Property Site Address: 55fInir <br /> o c <br /> •Contact's Telephone Number: 7/5' y/6 -3 ® a <br /> d <br /> Contact's Email: 0_`2,7:.r-n,;:, 143 & yAl-;v,), i:,z,rn 0 <br /> Legal Description of Property: 0 7G <br /> Section#: ' 10 3 Town#: - N Range#: I -I W Town of: 5[v it d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 0 <br /> Tax ID#(1-5 digit number; found on tax statement): 2 5`- 3S v) <br /> Proposed Use of Structure/Addition: ('A nA,9'L /Skb� o x <br /> Anticipated Start Date: 5//,:-; -2r.) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° 6 <br /> .-3Building Contractor: N g• c.°•',c.%cTa 4,2-7'./21,04,2-7'./21,0Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ' <br /> THIS PERMIT IS SUBJECT TO A CONDITIONS LISTED BELOW: o <br /> Nidt R- li-uw +N tk-* Yc z °\\ <br /> Co <br /> x,,. _.......______ -3 Fee Rec: /� <br /> N Check#: 4pJ- <br /> rn <br /> Date of staff site visit- )6/° Initials of site visit staff: y <br /> z <br /> Viz-*4-----. l 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Sl <br /> a1I4 F <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF trf <br /> < <br /> a o. $ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z w. C <br /> Transcendent: - Page 1 of 4 ki $g ^, = <br /> Laserfische: Burnett County, WI Land Use Application —Rev 1/2020 < = = C <br /> rii <br /> ° 3 <br /> y <br /> b <br />