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LAND USE PERMIT APPLICATION - Burnett County, WI a g <br /> b <br /> Applicant Complete All Sections Below This Line 3' in o <br /> N <br /> C <br /> a <br /> O NPermit Types and Fees:(Please,check appropriate boxes) <br /> -Dwelling/Principal Structure $300 IN to Dwelling/Principal Structure II " 01 <br /> =Commercial/Industrial Structure riti -Addition/Alteration to Commercial/Industrial Structure $200 sI\ O <br /> Pla Accessory Structure(Garage,Shed,etc.) IIIM =Addition/Alteration to Accessory Structure $150 c.1 g <br /> -Accessory Structure(Commercial/Industrial) $200 -Addition/Alteration to Bunkhouse $150 ,r5). Imo <br /> -\ <br /> Jv <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk111 <br /> IM Bunkhouse $250 <br /> Driveways/&Campground Structures $125 I=WI State Statute 59.692(ly)Structures $350 . p� r <br /> IIMFilling/Grading $150 -Boathouse $500 <br /> o +C' <br /> ok <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) 13I3 I w / . <br /> *NOTE:After-the-fact permits(permit aqui red 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 <br /> Property Owner's Name: k efrka rc! + L), v-c,ei ,.t t c,, D a. I ( <br /> 5,2 '7 S <br /> Property Owner's Mailing Address:• • 0 n .. <br /> F'47/0y vt Kd p .� , <br /> (( City State Zip z cc„ IP <br /> Property Site Address:02 5a '7 5 Ix(c1 n R� <br /> � � G rc.>145k, uhf W T 54F'9-y'a_ l c F p" <br /> Contact's Telephone Number: Sct90 y 8.3 - 7 s 0 ? <br /> ® a <br /> Contact's Email: ''�`► t r e b�a. I (® 1/a he o. Co m L o+ L( C 5 m 14.2 q (1 l 3 d <br /> Legal Description of Property: C 7 , 0 '/0 -Q -35 - (9 - 7- 3 U y '0° 0- °I14/(56 o <br /> UCiSection#: a 7 Town#: 3 ' N Range#: /9 W Town of: 111 a 5f' Marsh(Q Kd m <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number; found on tax statement): .3 S th <br /> ( 3 1 <br /> Proposed Use of Structure/Addition: o x <br /> Anticipated Start Date: A S C* P (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o S <br /> Building Contractor: Sewer Installer: <br /> 04 <br /> 1 01 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT S�BJE,CT T�A�L�ON II :IN S �LIS�F�D��BEt,OW:w Wyk z <br /> 1 <br /> = Fee Rec: 60CP- <br /> \it\Y 7 Check#.: 3 )3,o <br /> Date of staff site visit: lnitia f site visit staff: CD <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: a : <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y a z Cry <br /> CD (Dc <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT oa) IN4 1511 <br /> .< <br /> y n <br /> n; <br /> Transcendent: Page 1 of 4 rt Cl 7 o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 3 <br /> a <br /> LTJ <br />