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LAND USE PERMIT APPLICATION-Burnett County, WI a <br /> Applicant Complete All Sections Below This Line I. C o <br /> C l� <br /> Permit Types and Fees:(Please,check appropriateC <br /> yp boxes) <br /> CD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure J.19D, Addition/Alteration to Commercial/Industrial Structure $200 O <br /> C, Accessory Structure(Garage,Shed,etc.) $1 a Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 ° . <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 c111.- ' <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i-- P <br /> Property Owner's Name: 1 t r1\ C���} ,� o <br /> V <br /> o <br /> Property Owner's Mailing Address: . .tw , : • Slot)IL'A 1 A A Ir rV,// • m <br /> City State ip 'ff. n <br /> c44 I <br /> Property Site Address:A$a,(Q a )I Q4 3 E-)GI' °l "Y D 0.1 <br /> Contact's Telephone Number: 1Z 3—a�""75-g3 $3CD <br /> a <br /> Contact's Email: <br /> 1)I. t rnack51g 2 ocrtlook cem <br /> 1 <br /> Legal Description of Property: TO I I C(/h L-6+ no <br /> Section#: 4033 Town#: LW/IN Range#:/4 W W Town of: Oc ,jadn CAL --7 /1C11/10,4( aro <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax sys to property q <br /> n <br /> Tax ID#(1-5 digit number;found on tax statement): I '+4. , 01 <br /> CA <br /> Proposed Use of Structure/Addition: — s La — "' <br /> Anticipated Start Date: Del 1 V4.1 (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) 5 <br /> 1'YLQA-nD-viH <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r' <br /> i\1 0 A--- .F0(2._ Kumviv\ Rolot't,"\b,.** 6 q z i i <br /> _ Fee Rec:_1 <br /> x <br /> Check#:�'�,2 <br /> a <br /> Date of staff site visit: �P 1/4„Initi of site visit staff: �kLr <br /> z <br /> a <br /> 6# m <br /> APPROVED BY LAND SERVICES OFFICIAL: t �r''— 6�TE x ��� <br /> UPON APPROVAL: APPLICANT MUST POST CO 'Y OF a -4,- Ififil <br /> ? Nom <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o Ul] <br /> w n C <br /> Do <br /> Transcendent: - Page 1 of 4 A 41.1 g <br /> o <br /> Laserfische: Burnett County,WI Land Use Application—Rev 1/2019 �` <br />