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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 5' o o <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure _$200 .6.-- 0 <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 v <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° Y. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> Filling/Grading $150 Boathouse $500 ° 1• <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <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. - DN <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o g <br /> .c' 1 <br /> Property Owner's Name: --- - tf-1'ti 6 L(,SSC)�.� o <br /> Property Owner's Mailing Address: Z9 3(.- if(.07-I rL=L&i- L. :2-,Ji A tcs,. o 5 ,4 �l 5-1-b/ ° <br /> City State Zip <br /> Property Site Address: 72 Z 3 Fg-0-,, 5mO Ze_>r+=) 1,2431'&4' ". : :9r--11?3. <br /> Contact's Telephone Number: (.05 ) - 7 75-- /55 Z <br /> n. <br /> 0 Te <br /> Contact's Email: Et)/s.) Ci6soa +.5y? E Y4qoo , co✓"1 <br /> S. <br /> Legal Description of Property: (j flkL4—b 5 140 t `7 Lc.-T 1l 91.0CX:-. cra <br /> Section#: Town#: N Range#: W Town of: <br /> P <br /> *Attach additional page if needed for lengthy description OR attach <br /> a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): L.6 (�J 114.g.-23 <br /> '/8 J cA <br /> Proposed Use of Structure/Addition: t%tt[IL <br /> .-3 <br /> x <br /> Anticipated Start Date: `5 St).-1t. 7.o7/C, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: /16' Me:o--),-0-- Sewer Installer: !i /i9.. --3 Mb <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SU ECT TO ALL CONDITIONS LISTED BELOW: <br /> '' ON,Ok 1 lit-VA-1 (N GI\ Q ID 4-0-6A- i Ag„, S ----1.--bae k z 1 N <br /> tis c <br /> r% tA \ <br /> z D� <br /> Fee Rec: 13 <br /> Check#:A235- <br /> 5 <br /> Date of staff site visit: 21)O"" Initial f site visit staff: (7),,,r <br /> /, <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: 6/ dna 'v'' ' � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ® 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ii <br /> N <br /> ©? <br /> n N <br /> Transcendent: - c r.. <br /> Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> fill <br /> a `-----) <br />