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LAND USE PERMIT APPLICATION- Burnett County, WI • c <br /> Applicant Complete All Sections Below This Line 5 c e.• O <br /> Permit Types and Fees:(Please,check appropriate boxes) a. ,` <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 e 1,,(�+ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �"�J( <br /> .)< Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '�N g <br /> Accessory Structure(Commercial/Industrial) $200, Addition/Alteration to Bunkhouse $150 c. b ci <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 i .*".. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 < <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 d <br /> rn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. s <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> • g.• 3 <br /> 'Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c, <br /> 1 z• t--.. t <br /> Property Owner's Name: '-.1 t-`, .' O(' '`^ — <br /> ��^^ t r <br /> Property Owner's Mailing Address: .5-12 /("o Co,.n'4 ro:',1 t. ( 5:: A--- <br /> )'�.r.\:ti..t• t,• 545 3,-.) - <br /> CI <br /> J City _) State Zip 6 <br /> Property Site Address: fia-1 L,, C.t.{ CI c- ^ fff <br /> J <br /> Contact's Telephone Number:10 (a- G1, a'-i-10 < r <br /> i ` a <br /> Contact's Email: j__ &'-.4 r:-.......... [-k{e"•(�.1 •.l...o r- = <br /> Legal Description of Property: j. �jt -Co_ ._ it-\l,•N...5 Li. &{ CA15i <br /> 33 )vi .F a15 v <br /> - c <br /> Section#:S /`3 To��n#Tti)tlil N Range#:g.0f.` W Town of: J •.=LY;„?s...> ii <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r- <br /> Tax ID#(1-5 digit number,found on tax statement): S 3 is.,r1 `` . <br /> Proposed Use of Structure/Addition: 43r-fQt•`, tit,;. "', r-A. C).:r�'j� t-51,F:c`` - v) <br /> Anticipated Start Date: 6 '�0-4;3450 (ltomeCabin:Commercial Business:Bedroom:Deck:etc.) c <br /> Building Contractor: IC if Sewer Installer: "hit <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (� <br /> THIS PERMIT IS SUB ECT TO ALL CONDIT O S L TE BELOW: ('� v` <br /> 0 f o\lot3 v,Q de p, �� c c _ .--t 3--a C� ' — cam,yr. lie4e be41:iv- <br /> Y2 r kwacwA del t.� r p 6-. <br /> $ SGV L4 mewl KO' 4% 66 Wed 'ir I 'Yalto'^ <br /> 4e 5erfic SI,stom bW431 b44431k NrwkiwAtc•e/ ri*ecL bit /Wt 020 <br /> = I,,,Ree. 3,75 <br /> _Nee auxt/a.it 14116ervk UtI CCC . , J Check#: LO�(..) <br /> Date of staff site visit: , F • Initials i f site v'e staff: Op" <br /> • ` — aot3iJ ' Ir 1�cti C <br /> APPROVED BY LA '� E' 1 E OFFICIAL- __ , , .AW. . r TE: `2D2 O x7. '' <br /> UPON APPROVAL: APPLICAN i` 1ST POST COPY OF y ._- ---" <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ (,,c,s = . <br /> Transcendent: - Page 1 of 4 o o <br /> Burnett County,WI Land Use Application Rev 6/2020 1,...1a r <br /> Laserfische: - c K PO <br /> 1 L_l. J,a <br />