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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line a o <br /> I <br /> 11; a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,..t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 / g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r P <br /> Filling/Grading $150 Boathouse <br /> $500 P <br /> Six Month Camping Unit(One PerYear) $100 Permit Extension(1 Year Extension-Allowed Once) $100 e' i <br /> m <br /> o <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. C-- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. 2 <br /> 0 <br /> z <br /> Property Owner's Name: VIIIAW-QT k A TokA SQA/ ° <br /> Property Owner's Mailing Address: /034 51-AT-t Rt "18 Z-U GL w i S 5V$5.3 <br /> City State Zip d 1 <br /> Property Site Address: k <br /> 17 <br /> < <br /> Contact's Telephone Number: I / 5-- 5 .54—,) 2 3 0 a <br /> Contact's Email: A os 3 ov1c,5 0 % 1 g q z cog m p; f , cow\ CD <br /> Legal Description of Property: o ETC <br /> Section#: 9 Town#: l'lb N Range#: `4, W Town of: b eked ay" o <br /> 0 <br /> *Attach 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): 35-3-74-/ ^ <br /> Proposed Use of Structure/4ddition:�� � o x <br /> Anticipated Start Date:he-0 c( r0 �1) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CON VIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 740 /e 5urr 7 Mar fa;17 /D41- <br /> s i de Se'-- bac-k.5 <br /> 9tru.42+1/iNre_ Nom- C=oc t.,t,1Ylx►nr- �1vi <br /> - Fee Rec. <br /> 1 U Check#: <br /> ab <br /> Date of staff site visit: — 11C1) Initials 62 <br /> 4._o 'te visit staff: \\\V) <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: _ ��^� <br /> _ _,, r- <br /> 17,:? <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFaoa c <br /> z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z0 0 �, <br /> Transcendent: Page 1 of 4d R <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 < i r� Rn .. <br /> C <br /> L' <br />