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-e <br /> LAND USE PERMIT APPLICATION - Burnett County, WI k i <br /> Applicant Complete All Sections Below This Line g'' o <br /> A' <br /> Permit Types and Fees:(Please,check appropriate boxes) w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> tls t:41 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 s <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 j Iz 4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i� <br /> , Deck/;Patio/Retaining Wall/Sidewalk Bunkhouse $250 5 { <br /> 4 Iv <br /> Driveways/&Campground Structures $125 —SWI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 b ic <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1 .., U'c(— <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i ro <br /> *Items not listed above will be treated Qs accessory structures,such as:pergolas,landscaping,etc. g''' i <br /> Property Owner's Name: / , 16 CO . A i, <br /> CI <br /> property Owner's Mailing Address: c) I c N, Dih f) A�Q n,u, Lkra <br /> joi, i <br /> 0f�t � tx . Ql;br ,UlC`ity % State Zip 9 <br /> property Site Address: )cla <br /> 51417 <br /> Contact's Telephone Number: 1)S- cog�k- Clot n <br /> 7a. <br /> �I ,ci1 <br /> Contact's Email: ����� V�, (���� (\ (t ) <br /> Legal Description of Property: I <br /> U± Lit o <br /> no <br /> Section#: 61 Town#: o`i, N Range#: !1 W Town of: k u -iL w <br /> F <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): z <br /> Proposed Use of Structure/Add• •on: .51-61e- Ail i1;.;'f Io ,b(y.;( Le vz l 9 P <br /> Anticipated Start Date: I a trb(Jr& (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) 1 e <br /> IH <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I" 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Make_ stA tom- cte-ck 1/0(1/A 51,sit /5 of ActS/- 75 fee. z ' ' N <br /> 6 /7L env t:qke__ <br /> p r <br /> — fCe L U p- 17- / 4e more. . l eci64 �R) 5 , .3 Fee Rec: 102 Ye— <br /> Check#:1 <br /> ,/0 z-/-ee at, ,x, <br /> Date of staff site visit: Initials of site visit staff: 17; <br /> APPROVED BY LAND SERVICES OFFICIAL: '" DATE: /2,-3/2-0217. 0 <br /> " = <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF y <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Ifilil <br /> z (W z 15) <br /> MI <br /> Transcendent: - Page 1 of 4 n oc <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 4111 w 5. �' <br /> d 3rzi v <br /> MI <br />