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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o <br /> a ' <br /> Permit Types and Fees:(Please,check appropriate boxes) O k) <br /> CD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ��ir 0 <br /> v"Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> ,. Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 I ° E. <br /> \/t riveway /&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. U <br /> Filling/Grading $150 Boathouse $500 ° o <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn <br /> m <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. <br /> CD l <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r• g <br /> o <br /> �� �/ I i-: ,` <br /> Property Owner's Name: I G(1 ctiz't! 7))63-e.,- t a.t2 cit,( we P/ii(JC -no <br /> ° • <br /> Property Owner's MailingAddress:/ a <br /> p � l� Y�� �I J I� s ,�� /V w ��Z,n� in A/15S'f 3� <br /> yy,,,,,,,��, -- ,� Cify State Zip 5 n I <br /> Property Site Address: ar i ( Y o 'tryxd �_ <br /> Contact's Telephone Number: ry Z <br /> p lCv � — ��— '�- ��5 E. <br /> PD <br /> Contact's Email: '1-6c1c7[�. c-h eGZ, f'Y1 s 71-i f70�1. C U/7) <br /> // "C <br /> Legal Description of Property: GZr . .lz <br /> c .a ` ',Qec rt,o{ N <br /> > o0 <br /> Section#: 14 Town#: 'f0/v N Range#: /40 W Town of: (929 K fa_it 4 <br /> P <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> it <br /> Tax ID#(1-5 digit number;found on tax statement): /2145,& <br /> o 5 <br /> p � 9 / xLI ` x <br /> Proposed Use of Structure/ ddition: �1 +� j <br /> Anticipated Start Date: %dam IaQ ec.�, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - p <br /> .5'h — sZ /1.ta..er . / <br /> Building Contractor:.. S e4,'s ,GL.L, AkBS--r 4),-,Sewer Installer: '9/p42 <br /> Z.� <br /> ;UREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONSy LISTFD BELOW: <br /> t. NST F-& R kkm.c N i"A C1 o N z <br /> t \©. pub en\Ae plo-k- p\o,r\ <br /> - Fee Rec: 2?5 <br /> • <br /> 7 Check#: o` (5 <br /> 0 <br /> Date of staff site visit: a t." , 'I, dr Initi f site visit staff: a <br /> r z <br /> v <br /> APPROVED BY LAND SERVI' ES OFFICIAL DATE: d < <br /> UPON APPROVAL: APPLICANT MUST POST C PY OFff <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 2 <br /> Transcendent: „ = <br /> Page 1 of 4 r) 13 Q' u <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> o CD 5 <br /> Cna <br /> i <br /> b <br />