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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line ;c cn o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes)] \ C7 <br /> a.w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 a <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <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 r <br /> Filling/Grading $150 Boathouse $500 P. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 rn <br /> w <br /> 0 <br /> • <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> Property Owner's Name: 13r4 19Jle41. '-40— <br /> F.' <br /> f ' <br /> Property Owner's Mailing Address: 10 ��1C amt S d-A4," hiAda1Ar- p34/ ay i- rt <br /> 1!0 i 6 K.�j I g,,0".g,,0". �� City State Zipcn <br /> Property Site Address: <br /> �n 710 7/ X17 _,, <br /> Contact's Telephone Number: 11 © p, <br /> Contact's Email: b I/Ir4 0 Dc-S P r� i Co ri" rejw, t7 <br /> UON <br /> Legal Description of Property:1-0/- Z CSV* V1 b rit cr1 pn-t9 a V /o s 61 7 Scala" 3.L f� � � ccro <br /> Section#: II, Town#: 40 N Range#: " W Town of: Ski i)" 0.w <br /> K <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> o• <br /> Tax ID#(1-5 digit number;found on tax statement): grq r cA <br /> o <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor: Sewer Installer: `--1 -- <br /> AREA BELOW.TiIIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V\ <br /> z <br /> Fee Rec: i2 `- <br /> Check#: /g o <br /> z <br /> Date of staff site visit p��p�0 Initials of site visit staff: .6 <br /> I' v <br /> APPROVED BY LAND SERVICES OFFICIALS\i DATE: (9/lo1?.o .o <br /> a ro <br /> , . ' ....,,...c:-. <br /> ,._ LIR <br /> UPON APPROVAL: APPLICANT MUST POST -COPY OF: •- g <br /> 0 <br /> > �PERMITAPPLICATION IN PLAIN SIGHT `4 �= <br /> SIGNED-:PERMIT <br /> Transcendent: - Page 1 of 4 1Fe a Pi Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 !2 LE=D) <br /> �U <br /> I <br />