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C <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a � 2 <br /> s <br /> FN N <br /> Applicant Complete All Sections Below This Line o' <br /> I a <br /> Permit Types and Fees:(Please,check appropriate boxes) i ' d i <br /> spf <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 'c` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 EO <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> < ) . <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r-' <br /> o '5- <br /> Filling/Grading $150 Boathouse $500 ;" <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. C <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g <br /> I 5 <br /> Property Owner's Name: ��/ l5. C.-4d , c j i-, !~ <br /> P <br /> Property Owner's Mailing Address: 23',,2+-)'7 /i4 c err Z; e- LL„ 40 G c,/'t Q.,- i3�5(a©/ '° <br /> ✓ City State Zip E. er r--. <br /> Property Site Address: _2 gr.2( (+y A- , .5, c a ii v,^ j�.s..x- .± L/8'. 1 < ' <br /> / io g 1 <br /> ,547/(,,-- 2. <br /> Contact's Telephone Number: 7 1 4�/ //02 <br /> Contact's Email: k ,� �,� Kms✓-` q, �, <br /> �/ l2 v art c1" �1. � ,,07-1. , <br /> Legal Description of Property: G o 6 t (kJ 'A/ A-1/ /i) N b <br /> Section#: c.Z.3 Town#: 1-/Q N Range#: /`-t W Town of: r a 4 <br /> *Attach additional page d'needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a. 1 <br /> i <br /> Tax ID#(1-5 digit number;found on tax statement): /g t/,2`7 (1 r;o.— '„ <br /> Proposed Use of Structure/Addition: hi c> ,r - I 1 0 x <br /> Anticipated Start Date: Co- a9_ `�(`a (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) C7 <br /> Building Contractor: eke,"n..„4ruC-,Q, enc Sewer Installer: ,g9if,e_;i , r),,.et, fa.u'e( ;H <br /> r „ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 'z <br /> i <br /> z <br /> 1 <br /> i <br /> 1 <br /> Fee Rec:`r3 OO <br /> Check#: <br /> �Date of staff site visit. CP$ (9ccpc71 itials of site visit staff: ILk.1 -_- rri> <br /> APPROVED BY LAND SERVICES A V4:::5L"-a------------D- <br /> ATE: '&6 rri <br /> Po< r "_.-^' <br /> Gifil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ! W z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o 02, G <br /> 2 cc <br /> Transcendent: Page 1 of 4 p. ID`s <br /> Laserfische: Burnett County, WI Land Use Application—Rev 1/2020 r 0 [(�j <br /> to <br /> cn <br /> v `c^:: � <br /> S. <br /> K <br /> b <br />