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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> : � <br /> Applicant Complete All Sections Below This Line 5* • o <br /> a. W <br /> Pe it Types and Fees:(Please,check appropriate boxes) <br /> 7e m W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '-'6"-* <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 43 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° el v. <br /> < o It <br /> _ 'Q[iveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. <br /> o A <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ci' <br /> tm t <br /> *NOTE:After-the-fact permits(permit aquired 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. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r 0 <br /> ° z <br /> Property Owner's Name: t?)OQr&(I4jCI I ± / ' c-l LLC ,,, p <br /> Property Owner's Mailing Address:91? spa i•-q )1 IA)y 9i 13 5fr`fictio14i Si ! <br /> L //�� / �+ City State Zip r <br /> Property Site Address: .251'5 arm 5,4 ?1! d`obisy', 10/ t" 30 C <br /> Contact's Telephone Number: 7/3 - 39//h`I / o a <br /> B <br /> Contact's Email:)vhn be',e Ark el;e 1Ax C007 CD <br /> eLegal Description of Property:01)45,1 t/I4 o // V &lee- 12, 7 d'0 �L W i 7� o o°o <br /> Section#: C.O Town#: 90 N Range#: 161t/ <br /> W Town of: �'K Ike rig <br /> P <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):/V17� <br /> ,moi O <br /> Proposed Use of Structure/Addition:fi .- m J /v`�r,�,,6/�,r- / ,w w,,/At Z *5 ,( <br /> Anticipated Start Date:4,). 'I P (Home/Cabin/; mmeer�cial Business;er +Beedroom;Deck;etc.) t7 <br /> Building Contractor: / , ',- ,- , _,, i._, Sewer In ler: Y, //x/713- - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> $ Pe UetiAfrn rival, Gods Reriketmeisewwcst be Acct. p, 11 <br /> if'of ihSt 14U.44- Sfafe/Cocokhe rtet ui v v.444. x+S, <br /> -a {?moi- fciaitet 4se. se10x12 deck 6% 6,4414.. � <br /> • x Fee Rec:S`71-59 <br /> y Check#:---4—g <br /> . Fr-9R <br /> Date of staff site visit: 4/20.6,�Q Initials of site visit staff: <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL • DATE: (/�'�],O .I < <br /> UPON APPROVAL: APPLICANT ST POST COPY OFFi <br /> d <br /> a o. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z to z <br /> m gfi <br /> Transcendent: - Page 1 of 4 m go ,' c <br /> C N <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 m 3 a o <br /> a <br /> i L7-.`"D <br />