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LAND USE PERMIT APPLICATION- Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line g'5. <br /> = c <br /> ^a. <br /> � NO <br /> Permit Types and Fees:(Please,check appropriate boxes) w rD � <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ( `J <br /> Accessory Structure(Garage,Shed,etc.) $150 /IQ Addition/Alteration to Accessory Structure an g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> C" w 1. <br /> Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn <br /> P.! <br /> o. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 2 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. P <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t.., 3 <br /> 54—� <br /> Property Owner's Name: / `/ Ji y Sim-�---•— m z o <br /> IK roe F <br /> Property Owner's Mailing Address: J 44::> , 2 ) 'j f c-,95 74 L,�� ,CS-70.3,11,-• A <br /> ,� <br /> City State Zip ' n <br /> Property Site Address: 4/ j/er 7) 4 rl vi k' 1 <br /> o N <br /> Contact's Telephone Number: c-,---/ 9,5r--- 7/Y.5"- C • E. <br /> <—' o <br /> Contact's Email: JQ�er-Lo�L, V . _,// �/ , -C wt <br /> Legal Description of Property: 7�,/!t/ 4/ 4914ir and.) �,1 6'fri"/1 6 o <br /> tro5 <br /> Section#: A. Town#: 36 N Prange#: IC W Town of: ...rt r e,,,L) w <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* E. <br /> Tax ID#(1-5 digit number;found on tax statement): .:" d 9.3 O <br /> Proposed Use of Structure/Addition: 5 EZ / ?(/ -.45%L-Y) k <br /> Anticipated Start Date: /1S4- 3-40,14 '* (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° O <br /> BuildingContractor: <br /> -3Y1eSewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> t SJrcI 0 ka \--- CO- cpS6 'P/ 4,/ec,,,t/on Or <br /> A .p6-r- 6ynan Ilet-19/7"Q' icrl <br /> cht2--cl i`t6l `Df <br /> a kitto(A) 10-1— GlabnlitJe 6;��—plan m <br /> H Fee Rec: <br /> K� = Check#: YQ�� <br /> a9-Q <br /> Date of staff site visit: Init' Is of site visit staff. o <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: E;(0 rI� m I ► I1 <br /> 5 �� <br /> UPON APPROVAL: APPLICANT MUST POST 0 'Y OF cjr <br /> Ir <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Ci W 0 <br /> Transcendent: Page 1 of 4 A <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 o <br /> c <br /> m m <br /> a <br /> 3 <br />