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' LAND USE PERMIT APPLICATION—Burnett County, WI a 2ro <br /> Applicant Complete All Sections Below This Line 0 o <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 'D0,'' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v 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 G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r (\3 , <br /> Filling/Grading $150 Boathouse $500 g r , <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v' <br /> g. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. i 3 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> CD gbh <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S. g a <br /> z <br /> Property Owner's Name: \ I( t, Mcc 5 <br /> Property Owner's Mailing Address: 96,0( i., yr 1v -VT ra.c e_.) . rrw ier' PIN 31 3 io <br /> �1 Ci.ty J State Zip 0 cc„ <br /> Property Site Address: �55" C Wim/ f OCLU Li 7Q% ul' W I 5`1.3 30 .Z...7 E <br /> Contact's Telephone Number: f`J). "2-12. 12S 1 <br /> Contact's Email: 3 a)vv ii, Co i''Y\ CD <br /> d <br /> Legal Description of Property: i4U✓V' Lin (11)WA I1(1 (''u Z 7 ak, <br /> Section#: 14' Town#: 110 N Range#: i i W Town of: D(,(,{iii(V.6cro <br /> t,. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ^• <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): 13 2(11 <br /> Proposed Use of Structure/Addition: err" i <br /> Anticipated Start Date: c (4J AO)t , (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Cj <br /> Building Contractor: ,)Fj`(,�, 41\i 1L LO/ Sly 'Sewer Installer: C-r r 1 <br /> W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a Not ¶?- hum f\' -i-- v.-\-SN/ z <br /> O .1-=-040,) s u„b M;'fid p(Q l-p( h c &d (Ailacc c <br /> /„ r�� Fee Rec: � <br /> _5/9 <br /> L y Check#: 1'� <br /> d <br /> trl <br /> Date of staff site visit: dr Init s site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL. ------DA'CE: /0Z/dea � < ., <br /> UPON APPROVAL: APPLICANT MUST POST OPY OF N a ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , z.CD <br /> a <br /> N <br /> Transcendent: - Page 1 of 4 g g o < <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 < 3 `� <br /> rn m Y�1 <br /> v w <br />