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LAND USE PERMIT APPLICATION— Burnett County, WI 7 r <br /> b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriateCJ I <br /> C , <br /> YP boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `N O <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 w <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br /> $250. o q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 54.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 c <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. ;v <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g ~ <br /> r <br /> Z <br /> Property Owner's Name: t_ (✓t< r-i-ei Z t_e- o <br /> Property Owner's MailinTiqs: d( (p C (L� �avib t- �4�, 5 13 ' <br /> I ? City State Zip d <br /> Property Site Address: G,-- j? ( 4 <br /> o <br /> Contact's Telephone Number: 7S�6(. './ 3c) 7, • <br /> Contact's Email: ,S rev yk.c 0-a,-4_,t(..1e 0 vL C <br /> Legal Description of Property: 1 ci oto C©u ri Ki RA U SZ- 1'y S w Ai& o <br /> ao <br /> Section#: /9 Town#: y(J N Range#: /(p W Town of: ©eta,(C=.4'fc( <br /> *Attach additional page if needed.for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax Ill#(1-5 digit number; found on tax statement): /341/2 <br /> v) <br /> Proposed Use of Structure/Addition: ,c -c c -- iA-k; (i±/ 5 k €cA s Y <br /> Anticipated Start Date: Gt S a_ p <br /> (Home'Cahin:Commercial Business,-Bedroom:Deck:etc.) 5. <br /> Building Contractor: $�(- Sewer Installer: H <br /> �1 <br /> AREA BELOW THIS LINE:.FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r....., r..... <br /> N <br /> • Ma (ie. 5 t. 5 S -Pt bac/c -Cram road ee z <br /> N <br /> /Ike, <br /> f(\& cti fl 1710 'sethece-Prowl I[/ GenA,e/i4`'e. <br /> Nom- t O ►e‘ -V15 \o+ \ <br /> t Fee Rec: /509 <br /> Check#: -](c /9 <br /> Date of staff site visit: vi niti f site visit staff: <br /> iii I1 "--'/ ien <br /> 7 <br /> zrrr <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: yr �� r C� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF , w <br /> x <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> IM <br /> cn n f` <br /> Transcendent: - v o <br /> Page lof 4lc � �o <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 ^ <br /> co <br /> LTJ <br />