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LAND USE PERMIT APPLICATION- Burnett County, WI cr <br /> ►d <br /> Applicant Complete All Sections Below This Line s o <br /> ,, <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> Jr Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> 61 D <br /> Filling/Grading $150 Boathouse $500 <br /> g <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w p <br /> c. i <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. $ PI <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t- g 41,r,-,.. % <br /> Property Owner's Name: j j , ,0,7 f . _ 40 m� ° <br /> PS. <br /> S lb <br /> Property Owner's Mailing Address:139 ► � RS.A f WA' S'L{&9/ <br /> /n� � �'� c� City . % State Zip �; <br /> Property Site Address: // Ib 2 ,~ems 07� 7r. Cc . ,� <br /> Contact's Telephone Number: '2/ 5 - 4 '5 1 ' e 2 . V a <br /> d <br /> Contact's Email: <br /> Legal Description of Property: at4,44t ocro <br /> • <br /> Section#: A 2, Town#: S 7 N Range#: 1 g W Town of: 1, - �,r 1d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 71. <br /> Tax ID#(1-5 digit number;found on tax ,statement): Li 3 7 T v) <br /> Proposed Use of Structu e/Addition: ,4:3 /-I <br /> Anticipated Start Date:< 44,k �y,l-1,t1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �� O <br /> -3 <br /> Building Contractor: ,,U 4 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> is <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 004.46#004.46# k, ottoivett a or tkuriauce iuust toe rouhcd 1z <br /> 41 <br /> ba I6f0.02,6 Are 'WS prnwt fa 64 r*td. <br /> All kclnowrkS wtt4St k "'not "V""( Ikc P5? I elimckist <br /> 431 f/oU) . co <br /> ; Fee Rec: `6 — <br /> S <br /> ,31 Check#:La03/ <br /> 0 <br /> Date of staff site visit: G/ 2,07.1 Initials of site visit staff: a <br /> z <br /> / / 0 <br /> APPROVED BY LAND SERVICES OFFICIA DATE: Y /2/�� ��„J <br /> UPON APPROVAL: APPLICA UST POST COPY OF Fi Q 1M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT EITz a? <br /> Transcendent: - Page 1 of 4 0 ay <br /> m .c° <br /> _ 2 c4 <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 < 3`` <br /> m fD N� <br /> C <br /> LTJ <br />