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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> ' <br /> Applicant Complete All Sections Below This Line = = o <br /> CD <br /> , <br /> • <br /> ` _ <br /> (V <br /> Permit Types and Fees:(Please,check appropriate boxes) d G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `"16.— tQ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> F <br /> -,/' Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 d <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° � rDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r C <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 „ <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. q , <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. C• 0, t <br /> 9 <br /> � z <br /> ../ <br /> Property Owner's Name: .4- U ; 171, Gd r e o kil <br /> r' // oo 1 <br /> Property Owner's Mailing Address: ? Be A 4,45 5y. C a o i ti-cc.6`5 ,i .�l/G�4/ I <br /> City State Zip �. <br /> Property Site Address: 3$ga f c,.w ci 1....6,, e__ .Dr. .f. ,2.2.,f, W,- 3-09e> <br /> Contact's Telephone Number: 7j16-- Ss dd 5 U 7 , a <br /> ° d <br /> Contact's Email: fir n, <br /> Legal Description of Property: I----at- - L' Srr \5 e 3 y a- <br /> Section#: 13 Town#: u I N Range#: t W Town of: w 1 S S <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* T <br /> Tax ID#(1-5 digit number;found on tax statement): ,9/3 3 - <br /> 3 ,,, <br /> �� a w <br /> Proposed Use of Structure/Addition: m r �j� ,g h, x <br /> Anticipated Start Date: 6- 3-3. 0•o (t me/Cabin;Commercial Business;Bedroom;Deck;etc.) Cj <br /> Building Contractor: Pre ' ;/i Sewer Installer: A. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �' N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 01 <br /> pelt- Fo $^ i-\ \O V k k_cd91-he '0 u NJ z W <br /> >< Fo'q0K,3 Subs c--QA 916 1D(a fl <br /> -1 — <br /> H Fee Rec: 0 <br /> in Check#: I is Lt t <br /> 0 e <br /> rer <br /> Date of staff site visit: ` YIni,'als of site visit staff: tj\ a 0 <br /> fiThl <br /> APPROVED BY LAND SERVICES OFFICI• t : ATE:&,-18,......„9,, <br /> , '-~ n. Z �v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF la t f <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o G <br /> Transcendent: - Page 1 of 4 - <br /> Eill <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 Lc JJ <br /> H <br /> a <br /> 3 <br />