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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Applicant Complete All Sections Below This Line o' • O <br /> c. <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> Dwelling/Principal Structure $300— Addition/Alteration to Dwelling/Principal Structure $200 (v <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 , g <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 i <br /> Filling/Grading $150_ Boathouse $500 06) ,� <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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- 5 <br /> 1 ` � c <br /> Property Owner's Name: • (\C`C� N\ h1 I^ p lb <br /> Property Owner's Mailing Address: t C, 1 (U� j �K14 j\ : 5 L x I -o i <br /> 22 City State Zip <br /> Property Site Address: k CR D. uk a.,tx3(r' Regi rt - . 59,6t), <br /> 1�< J .O OE3 .S <br /> Contact's Telephone Number: a <br /> C��(1 i Q., c1Ev:, C d <br /> Contact's Email: �� �TfoC����Le rr\!� ' _1 `; <br /> Legal Description of Property:Se.c.3(o -S 40� KAIL iVW�" PCL Gov 44 1 N " <br /> Section#: 34 Town#: Li V' N Range#: i _I W Town of: ti a• I• I <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 1 Q ?.,:.9' <br /> Proposed Use of Structure/Addition: 46,,t-0, o x <br /> Anticipated Start Date: v (di 2c, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) =• p <br /> Building Contractor: 14c.v - Sewer Installer: Q P1 <br /> D <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: . ,� <br /> b AA. 4e bt cased 4or, hick ha4o#641oN, A 6 pow 6►11, 6010We612.. z pO <br /> x <br /> -a Fee Rec: <br /> x <br /> y Check#: 3iO3 <br /> 0 <br /> Date of staff site visit: 6/3/202.0 2 _ Initials of site visit staff: a <br /> APPROVED BY LAND SERVICES OFFICIA e .v ATE: /��Z 020P ;___� <br /> oo <br /> MI <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF . a .. <br /> Et cz 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT [N�71 <br /> m Cc, <br /> Transcendent: - Page 1 of 4 vz V <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 sPO <br /> LTJ <br />