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cn '11 <br /> LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> Applicant Complete All Sections Below This Line z o <br /> a A <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> �V <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> D0> 1eck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> riveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r. <br /> 0 <br /> Filling/Grading $150 Boathouse $500 S <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 P <br /> w <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 6 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i-. 2 (�� <br /> Property Owner's Name: DA Y,! J inc Calutet "1- G/gr� Va, `! <br /> y - <br /> nn / o � . <br /> Property Owner's Mailing Address: Ofro�o�a �i sr. N6 �� '�, C{t iil1r- 511 w 1 <br /> ity State Zip o Q <br /> Property Site Address: 9aoo S btrq E _a. ..NI- <br /> r _ J J C_ <br /> Contact's Telephone Number: 6g a '7i3 0 � ,S7c'3 29a-2� o a k <br /> Contact's Email: 6. —rwu1 t�, e. klAhwQ ,Go)r� d <br /> Legal Description of Property:ScQ�Akareit�,0� oo (j <br /> Section#: 03 Town#: 3 O pN Range#: 17 W Town of: Q pn i�(S '�'4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* _ <br /> Tax ID#(1-5 digit number; found on tax statement): i 5 . cn <br /> Proposed Use of Structure/Ad.ition: hit/ a c ' ip_ii,_ .,,_1:: c d� ►, <br /> .- .ala 1 • • k <br /> Anticipated Start Date: , _, • (Home/Cabin, Commercial Business; <br /> Bedroom:Deck;etc) <br /> a 6 <br /> iBuilding Contractor: Sewer Installer: ar/y i CJC,d(,o' y AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -./ Ilk <br /> �M,J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: —. , ` <br /> -,---.c),,,2,f P‘ k- ©(2-- e- 10 am d WQ C l 1 n5 z (1, <br /> n9 c <br /> - cCe� , � cL Uc vv res Na 'MC-'MC-t#� 1 <br /> (011.1'42-c--.1Cln ti Well/tq Q inr �o�' mare_ <br /> o f ben i I p <br /> n SpeC"�i Q t l S cf 11 2 l' ,an 7/�`�Z�-�y x Fee Rec$' -25 <br /> Check#: /2n1 <br /> o <br /> tz <br /> Date of staff site visit: / Initials of site visit staffAi: <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: c\iti/Nkr-0---"'"-- � —SATE: 6 i rr•i a < __.�- <br /> , g- <br /> UPON APPROVAL: APPLICANT MUST POST 0 PY OF a r.nW n <br /> 41 ?.3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r y e o ff <br /> -< 0 c <br /> Transcendent: - Page 1 of 4 II S <br /> m 3�` co <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 < 3 <br /> m <br />