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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> g b <br /> Applicant Complete All Sections Below This Line 0 o <br /> CI. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> (�v1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " -\ <br /> ,['� <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk X( Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> a <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 0 .J)^ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t-• _ <br /> O i ' <br /> Property Owner's Name: v, je) S Pec � - e 1\'k`�l"` �, l <br /> Property Owner's Mailing Address: 21 c 01 C n C ey 1 �`- e;y. ("i�" �-(/ b " ,r <br /> I City State Zip / 0' <br /> Property Site Address: 5 AA wi 5z-i 3'C E 0,,, <br /> \ <br /> Contact's Telephone Number: ) 6 `'I ---c‘\''. .55 Z_ o a <br /> 7 '�-� <br /> d <br /> Contact's Email: `�'"53y he-)\°+1 3 Y,�`, I.. `a,,, Ili <br /> Legal Description of Property: 1. ..'T3 c->/t-M V i ,'r' 61.“ Al. t 0`7 I' d 5.,'t( v)p ,S 1 tl s )ii= y <br /> , <br /> Section#: .3 6 Town#: 11 I N Range#: 110 W Town of: S1,3 ►s S '2 t 3 ``." '12')'': o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system prop properly pag.4.' j 5 <br /> n <br /> Tax ID#(1-5 digit number;found on tax statement): a la 33 7 a, <br /> �` <br /> Proposed Use of Structure/Addition: H r11C 6->.-A5 4/ et r�o� o <br /> Anticipated Start Date: Ja,y . c77-O / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t7 <br /> BuildingContractor: d P kz r / �`s� H C� <br /> �ra e Z ��.,,L�, Sewer Installer: � <br /> E k)) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rk-A' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v) V-1 <br /> a U C ect S u.S`-be c b to\.e d o bank to S' 11\51= -)-(Cil' z N1 <br /> Q-- <br /> ii 5Uv .P Z ' c- Seto r yr WAS 1-$� % i ©rt p n 4or 1— po <br /> ram he Souk S 1 <br /> Sicie � 6 syll I <br /> ` `� je ons <br /> but04.Muse "1-1) be. bum ct6)vz gip. qi-e .kne Sea. to ve- , <br /> 47 <br /> Fee Rec: �' — <br /> Check#: $'99t a- <br /> cA <br /> �� v <br /> Date of staff site visit: esu' ? Initials o ite visit staff: y <br /> A <br /> ti dAPPROVED BY LAND SERVICES OFFIC E: (� <br /> rz <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a 43. <br /> co W X 5 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z ti <br /> r <br /> Transcendent: - Page 1 of 4 m 3 n� e <br /> C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 r' <br /> e <br /> a <br /> J <br />