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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o* o <br /> a. <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 /> 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 <br /> C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 '' ' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r 1 <br /> Filling/Grading $150 Boathouse $500 <br /> 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> II <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. @ • <br /> Property Owner's Name: ��M y T ' 1 O rs c- <br /> 5#830 i' <br /> Property Owner's Mailing Address: 22E(2 I East 3 as s Lake/2c act ba'ibury &T <br /> City State Zip I <br /> Property Site Address: . Mc, E <br /> Contact's Telephone Number:-7 15--74(i1-10(e I a <br /> Contact's Email: 01 C ISE-4-0011 m y i g®\)a JDO CO im CO <br /> Legal Description of Property: S Vv \/L] S E 1 V---IN <br /> u� <br /> Section#: ( 2 Town#: 4 ) N Range#: 'l W Town of: L(1!On t7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systemproperty page.* <br /> Tax ID#(1-5 digit number; found on tax statement): t, 6I g L U~1i\ 352'1'// 4- <br /> cn <br /> Proposed Use of Structure/Addition: Sk�r <br /> o , <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^� <br /> Ter w\ L'k-\--c�a ' SA-e,.t ,' , °. <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> k 60twa+ 48 be used 4v kukuat t iLi e lA <br /> Septic SissfeAm nu*/ ibc serviced iota 1/2020, <br /> X at c e s nod atowedQ M RR-/ Astrkt (Atka C444 7%44 Gist <br /> SUbN�iflC x Fee Rec: <br /> } r 4&21 IS d ! app' ed• V' Check#: 563 <br /> 0 <br /> Date of staff site visit: 6/20020 Initials of site visit staff: <br /> 157/ /2ozo rnz <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: 6 <br /> UPON APPROVAL: APPLICA UST POST COPY OF 7 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o g( -- ff <br /> ton Oc <br /> -< va <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land,Use Application—Rev 1/2020 < g 5 <br /> mM <br /> D <br /> 3 <br /> -o <br />