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LAND USE PERMIT APPLICATION - Burnett County, WI = g b <br /> Applicant Complete All Sections Below This Line 8' G o <br /> N 1 <br /> ,` <br /> (v <br /> Permit Types and Fees:(Please,check appropriate boxes) d W <br /> X�Dwelling/Principal Structure $300, Addition/Alteration to Dwelling/Principal Structure $200 De� <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 . i <br /> Accessory Structure(Commercial/Industrial) $200 'Addition/Alteration to Bunkhouse $150 n <br /> iDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 p p <br /> 0 <br /> Filling/Grading $150 Boathouse $500 I, <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ' <br /> o <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. w <br /> `Comrnunication Towers&Signs require a different application form;see corresponding application,and fees. b <br /> ..ki}_ <br /> 1`h-ems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-. 2 <br /> 0 <br /> / o <br /> Property Owner's Name: /71 E i ri5 . c c Y It h S ci c- t ,y <br /> Property Owner's Mailing Address: ..- -.5—e 1 5— — / i� /'- 3.-27 /v. t ' II <br /> Cit Sta e Zip F.' <br /> Property Site Address: 6-'6- -0Z .-;2 Li e',r{r [7 (U. /'�<, n ✓�.r �'f 3D C <br /> '' <br /> Contact's Telephone Number: E'/ 2 — 65,9 y — 3 6-i I a <br /> ? <br /> Contact's Email: --Ca' viz e/-. ___Las. /J 0�'S %”4'i". C'O p 0 <br /> �,��jj <br /> Legal Description of Property: --CC-;a7Tt - l•e r f o as <br /> 5' <br /> Section#:;2__3 Town#: Z9 0 N Range#: / 7 W Town of: (.41 / p rt c ( <br /> *A trach 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/ 7-'%e) iv, <br /> Proposed Use of Structure/Addition: biC„yi ,✓ C---e-,2„‹..„./ E 0 k <br /> Anticipated Start Date:_,. 2v„ U (Hon /Cabin:Conuneal Business;Bedroom;Deck;etc.) ° d <br /> Building Contractor:`j/g -T T . 21 f /11 7 4� , Sewer installer: /fs � <br /> ,h i h r./ H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> it 51/' Wide M441. be (44CCot aiu-au a all covtIMAd' t 04prOpeih ) as x <br /> Well as ovemk nd(w septic. fat& $ w.otcwat stetes441 &Act loft Iattto i4, <br /> el $frc Ccre wt.$+ 1oc C6 rwt -Doiellitl, Coda 1Kspected. <br /> ill geamvtecfiovt -fp 1P'003 must- be perForst,eot Ids. WI Washer P64.46‘,,r, 3�Ca <br /> - Fee Ree: <br /> ' Check#: 173 <br /> le Pi <br /> LAt- <br /> Date of staff site visit: $ �/2.0 ZO Initials of site visit staff: <br /> // d J <br /> APPROVED BY LAND SERVICES OFFICIAL: ,i.,, A,„,,,,,. /_ ,, 4, W_ 1 ATE: (O / 202.0 d <br /> VI <br /> r <br /> UPON APPROVAL: APPLICAN * ST POST C PY OF a W n ON <br /> i2 gnSIGNED PERMIT APPLICATION IN PLAIN SIGHT2 2a o <br /> gill <br /> r <br /> g C N �, <br /> Transcendent: _ Page 1 of 4 m N / <br /> Laserfische: _ Burnett County,WI Land Use Application—Rev 1/2020 �` c' <br /> 9S litil <br /> y l�'7) <br /> i <br />