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LAND USE PERMIT APPLICATION - Burnett County, WI a _ b <br /> ' y N <br /> Applicant Complete All Sections Below This Line o a o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> \ r <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "6— <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> _Accessory Structure arage, hed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,t t! <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125_ WI State Statute 59.692(1v)Structures $350 r <br /> 9 <br /> Filling/Grading $150 Boathouse $500 <br /> ` <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 0FS <br /> *NOTE:After-the-fact permits(permit aqui red 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- 2 p <br /> 0 <br /> Property Owner's Name: ( ,;.) — 4— <\1\0=A1 ' m <br /> F. <br /> Property Owner's Mailing Address: ©et A j Pe_,r-N V}, ,\ LY\ . U,t, j'4 e..r . <br /> CitL.)-T___ __4_7 __State �3 <br /> Property Site Address: n '`� <br /> o <br /> Contact's Telephone Number: Sq — c rp. <br /> w �Q_ � 0. - NPACk; • C��►/1 <br /> Contact's Email: a <br /> Legal Description of Property: G-,91 Z / p eAA /l r/l Ai) 7 Ur U, o <br /> J. <br /> Section#: 02' Town#: 7 0 N Range#: /.S W Town of: 0(tC C d Ncm <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): 6 3 Z _. r„ <br /> a -I <br /> Proposed Use of Structure/Addition: Qoe, -t f k <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) a ° 6 <br /> d C <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ( W <br /> THIS PERMIT IS�SUBJECT TO ALL CONDITIONSLISTED BELOW: N <br /> — Ne9/- 7' V 4 e. US`s/- 1/' A u vH a vt 1 cU 17 & z <br /> %Po \\I <br /> -, 5 hAu du✓`.e_ A4 LAs71- be- 4i- leers/- t o l eS- <br /> )1'm e_ C-d,►.A $4o AA- 70 /0/ / cc>^cj 2• <br /> —somlr-cfry sy skAA1 IS de -E r Se,sti 1~.1J in 2-0 2..00 FeeRec: /S� OP <br /> Check#: 1330 <br /> Date of staff site visit: C2/ ?iZ/ 7�?�i Initials of site visit staff: "�// e-T. <br /> !// I � -- <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �� 3 zo � C� <br /> f <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF rm <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT [Fifa <br /> Transcendent: Page 1 of 4 cD <br /> c <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 °-; 'Nil <br /> ) <br />