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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 5� o <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) o r-- <br /> CD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 IF. gO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N 2 <br /> AccessoryStructure Commercial Industrial <br /> (Commercial/Industrial)) $200 Addition/Alteration to Bunkhouse $150 G') <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> /" ° ►b`` IS <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(l Year Extension-Allowed Once) $100 `" ..LS , <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. P <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I-- lb <br /> z • <br /> Property Owner's Name: C4& 6-4..,..f'.1YG /V1"4-0,y )3:4lZ A 1-7"Tp <br /> n <br /> 0 <br /> Property Owner's Mailing Address: /911`! C c)Pgic 1-/' A v _ yrPAiAL //AA/A/. 3 ie c <br /> In 06 <br /> City State Zip� c r„ <br /> Property Site Address: 4.25-896 W E-Sr 6'.�s5 t 4A(t /CD_ A Er357E�Je y1t. $YE 93 < <br /> • <br /> Contact's Telephone Number: 4.442. Pa' - 379 7 o — <br /> 0 v' <br /> 0 <br /> Contact's Email: <br /> 0 �- <br /> Legal Description of Property: o ac <br /> Section#: A3 Town#: 31f N Range#: /6 W Town of: /11 L Lexi o <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): /175 5 r„ <br /> o m <br /> Proposed Use of Structure/Addition: L r{ka hS S S 1'/�l if. x <br /> Anticipated Start Date: (Home/Cabin;;Commercial Business;Bedroom;Deck;etc.) — C7 <br /> Building Contractor: calk.c f,4M F13 f/ Sewer Installer: -s 3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIQNS LISTED BELOW: 0 v <br /> �aAZiA q dy./fie 7a n ,4, i <br /> V 7{0 40 /r7ev c? PI . `0 st <br /> - Fee Rec: I a�C— <br /> ' Check#: <br /> Date of staff site visit > �a,0 Initials of site visit staff: t)kIL <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: I DATE: 6/��zo Zo cn <br /> rn <br /> cn r � <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF cn a <br /> o <br /> ��� Z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .7 y c-„ <br /> -< 0 = <br /> Transcendent: - Page 1 of 4 n 2 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 n< ['�� <br /> g Qi <br /> a <br /> D <br /> 3 ' <br />