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LAND USE PERMIT APPLICATION—Burnett County. WI t 0 <br /> y .N ro <br /> Applicant Complete All Sections Below This Line 0 . p <br /> a 50 <br /> Permit Types and Fees:(Please,check appropriate boxes) ' <br /> NA <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `I.' 0 <br /> X4Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1� g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 "Xj <br /> F <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S. <br /> Filling/Grading $150 Boathouse $500 .' <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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> � ;� <br /> Property Owner's Name: ' tlCl.kAc k 1 tai 6" / T+-'d i y .i- it:M Ill0 „ . <br /> Property Owner's Mailing Address: C'1'i y ' j{ )• - 2.-`I Off` .Seh.)A%,l:ew -,c.T b <br /> / 1 City 11>ISit,y,S,5State j i,fip_s31 7 .� <br /> Property Site Address: /`//Y(,, .-1,..%k-f-�,,i, Z t; —6 r ct ryts tai,r'i L ti 1 -C X i <br /> y <br /> Contact's Telephone Number: (e`.> 1 - Ll 37-/..:24.,,P / t...:,..5-/ - Li 3 7- 513 1 o C�/ $. <br /> d , <br /> Contact's Email: '}7ur?Lakrc -L ')Co.” d,si r)-1 /{M'•ieir4.1fV)0 0 kic.,l. Ct'=14 . op t <br /> cC. "7 a ..,�` N b <br /> Legal Description of Property: Ti ,� Z / i t1 S i v (.� i9 S/_ 4� }�,� , — <br /> Section#: 7 Town#: 73 N Range#: / q W Town o£ LU.( /1,144/,j1,1.44y yy o rzc— <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 3 S Jin 8 . <br /> Proposed Use of Structure/Addition:..c4-ergN L /I S t(Qell Q'0.\\C-4;4 f 0 Pic i <br /> Anticipated Start Date: (t. A-I • z C t..C (Home/Cabin;Commercia usiness;Bedroom;Deck;etc.) G <br /> Building Contractor: Sewer Installer: ,-.3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELQW: <br /> IS- <br /> 41\©Ce Coc ��4\e f S►\ec4 (16--k- F4�W <br /> c \ek Y\ z o() <br /> 0 <br /> {' i k 7cocf .-Pcrte' U .1e year . ,re,in )S$,tte0. ., <br /> Fee Rec: i�lJ- <br /> '/ t <br /> � tv Check#: y I PP <br /> m <br /> Date of staff site visit:6 �'� Initi of site visit staff: t"V) <br /> APPROVED BY LAND SERVICES OFFICIAL: :r,? plY. y. <br /> ___,.0� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '' <br /> Ififil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 5f <br /> NJTranscendent: - Page 1 of 4 i <br /> v c '"' <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/2020 F, 6) Q <br /> i <br /> 2.41) rCu� <br /> lc---?) <br />