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LAND USE PERMIT APPLICATION — Burnett County, WI a -� <br /> Applicant Complete All Sections Below This Line CD o <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> F' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 _ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 X E <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C� 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ro <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 11) <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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g. <br /> r <br /> `' T z <br /> Property Owner's Name: 1 `'�."C�.r//�'A7C.; •�1 i /A' iia o <br /> � , Y <br /> Property Owner's MailingAddress: o ' 7)- t' " �) �e ````f�"' t t1 <br /> (+ ity State Zip cn <br /> Property Site Address: ¶ /+ f 1 P. .: .S"/� 4 <br /> Contact's Telephone Number: / 7s J'--"?,,.7 - 4_/ 3 o_ `� <br /> a <br /> �, � C' o <br /> Contact's Email: jii i�p�7 ij7/��; �..�( i(;�� �. t C, _./)1 <br /> Legal Description of Property:Ck pL/)/ /1-- t 2 1-,,L• yil e RWi/ .- Zt ;'7 6 00 <br /> Section#: Town#: N Range#: W Town of: y - ; . Car' j 70 <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): SZ --/-- fga <br /> Proposed Use of Structure/Add'tion ( R f;L IN UC x mgRikr C C ° x <br /> Anticipated Start Date: eel/, /..CJ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> r ri <br /> Building Contractor: /4'A1�5 .:A/S � l Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDIITIONS LISTED BELOW: G <br /> t--°\\°W inft i#tieri V.6� 001/4n z <br /> H Fee Rec: <br /> E7 Check#: 17` / <br /> Date of staff site visit: C1 Drs"Initials o site visit staff: Y a <br /> Ko2<____,IntTrk___-18.--doc96 z �oAPPROVED BY LAND SERVICES OFFICIA : z ,- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a m z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o y = N <br /> Transcendent: Page 1 of 4 m a,Z N <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 PI a GU <br /> m <br /> b <br /> D <br /> 3 <br /> ro <br />