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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ba* cn o <br /> PP P ii , <br /> Permit Types and Fees:(Please,check appropriate boxes) m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `' -{� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- G <br /> 0 <br /> Filling/Grading $150 Boathouse $500 II <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. s ir. <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. t-' g e <br /> o , <br /> J 01r 1-1 Gi U 1.1 C*-}- z <br /> PropertyOwner's Name: ,,., <br /> Property Owner's Mailing Address: 2-4 2. S 4- t.-ko vu E 1 VJ T Ere—w� t ;--42)93 Q <br /> City State Zip 5' e) <br /> 4 2 1- <br /> Property Site Address: 2 5 4- -1-D . W F T e-i2-- W t I 5 4.(2)`3 3 '' <br /> o y <br /> Contact's Telephone Number: e3 G.2-- 9 24-- S 17 b g, <br /> Contact's Email: 1 CAn t'1 J C.1 j.23 j e msr •co t'Y1 ? <br /> Legal Description of Property: LO T S' LSM #2O 6'S V I P 246' (-i.25°488) <br /> ag <br /> 0. <br /> Section#: g Town#: 3 e N Range#: 15 W Town of: LA l`O 1—LETT . = <br /> O. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* n. <br /> g <br /> Tax ID#(1-5 digit number;found on tax statement): (v 2-8 <br /> cn <br /> Proposed Use of Structure/Addition: & 412-,6, E. ' <br /> Anticipated Start Date: -3 U L-( 2.0 2-0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> Building Contractor: 1-4 E-VI-At-44 60 I Lt7 U-41--'S Sewer Installer: 1i / . 'i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a <br /> 1\j` —\ `fin z <br /> q <br /> 1 <br /> z Fee Rec: <br /> Check#: 574Z <br /> 0 <br /> 0 <br /> Date of staff site visit: )/ /?O Initials ite visit staff: <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL /�TE:b 5/;‘D:140 cAtr <br /> < <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Cr <br /> CA r- <br /> j-,1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z z co > 0 <br /> { GjTranscendent: Page 1 of 4 m a, n <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 < o c <br /> Fit3 <br /> b t C=:2) <br />