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LAND USE PERMIT APPLICATION — Burnett County, WI a ro <br /> b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes)_ d N <br /> co <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> )< Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t=- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year 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 /> I. <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. r <br /> ! � ^ `� o z <br /> Property Owner's Name:C, i-//i-e faiy, i fy L;(14')1, �ciLS�I" ,-, p <br /> E <br /> I L � � �] <br /> Property Owner's Mailing Address55p 0e .6 �f c^ 1 1I LjS 4- f3 !r�� , !) Z7 <br /> r ity. State Zip• = v P <br /> Property Site Address: 44, I • a , ,4 • 1 I �r. <br /> Orr <br /> Contact's Telephone Number: kr/ 643,s- 99.7,3 � n. �� <br /> boto <br /> Contact's Email: 3-A U. / 3 e Y i Co rri <br /> Legal Description of Property: o oc, <br /> Section#: Town#: N Range#: W Town of: <br /> u. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> F <br /> Tax ID#(1-5 digit number; found on tax statement): 79a3.7 <br /> Proposed Use of Structure/Addition: �{ r cuye .x <br /> Anticipated Start Date: (/I, ' E] (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t7 <br /> Building Contractor: L f r p j Sewer Installer: 4j/4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7C <br /> THIS PERMIT IS SUBJEC TO ALLcc�NDI LISSTED BE.I*OW: d v <br /> e Ivt.- - V kAU�Y Ilk—N.1 i -cc kCIN z 0 <br /> Po <br /> jI m <br /> H Fee Rec: /L <br /> c7 Check#: ,2599) <br /> Date of staff site visi : a 4D'` Init•! s of site visit staff: )L---- <br /> APPROVED BY LAND SERVICES OFFICIA DATE:62 3 !J�D c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> a 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o $ N <br /> H n N <br /> C <br /> Transcendent: g m W c <br /> Page <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 <br /> R. <br /> a <br />