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LAND USE PERMIT APPLICATION — Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line o <br /> a <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> a <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 3ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� E- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> A. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i=- <br /> o 41kFilling/Grading $150_ Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <br /> F.. <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. -a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- g V <br /> ��.y / oz <br /> Property Owner's Name: /��rh I' Vt o7 6�Atiod ,Sk(IV/IY G V5r P L\' <br /> p Y -n <br /> Property Owner's Mailing Address: 2• Lee- Atr ale N. /1) Y 07~ � 0 <br /> R <br /> la <br /> City State Zip = r„ <br /> Property Site Address: J1.( RAC(a.- 0itl/Lr SImr+4,r W,Z 5'ACI <br /> p €«• 6/8 • ?Ion a . <br /> Contact's Telephone Number: <br /> Contact's Email: 1��/ �S^@, /� <br /> tit • ty, <br /> Legal Description of Property: LA. MCi<vtSit. 74,/lviS/ t91:4 tr4-6 ti' 'J"+`~ ao <br /> S <br /> Section#: Town#: N Range#: W Town of: �Oft" l <br /> cro <br /> u. <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): 1 (D63 r„ <br /> o <br /> Proposed Use of Structure/Addition: RC Si4 s � H H <br /> x <br /> Anticipated Start Date: MA 2.0)4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) p <br /> Building Contractor: 13(1T1 P si Sewer Installer: 404— H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • ,,„„ , A}— S — C I d SAPS � .e f r V of w� <br /> ,� - Qpv <br /> ,_gyp <br /> Fee Rec: 1oQJ— <br /> y Check#: rd9 <br /> 0 <br /> Date of staff site visit: / / . i/ / Initi s of site visit staff: �� a <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 5/ /010612 <br /> Fi --Jttl <br /> O <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a r <br /> fil <br /> x. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT “g2 0` <br /> Transcendent: UuU <br /> Page1of4 `'' c� <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 < T Q <br />