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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Applicant Complete All Sections Below This Line 5 r, a <br /> Permit Types and Fees:(Please,check appropriate boxes) nv C.► <br /> , <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 ddition/Alteration to Commercial/Industrial Structure $200 f <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 nkhouse $750 0 <br /> • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- , <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 n <br /> 'NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. g, <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. <br /> Property Owner's Name:,%/L A (.' 7".4, <br /> -,/r td1; e 17/ - { <br /> �i P <br /> Property Owner's Mailing Address:3 9/2 ��'^e .4� 1. 4-4 v `G'•.Iii'""` �t A/ 5-c/ <� 3 1 <br /> ,� City State Zip 5 i' <br /> Property Site Address:`j�-5-7_7 /Ju=„A r'r.,�r >I et r .&.:,--e f,..,--(v._ 14,-.1 • e? <br /> < r <br /> 9iv <br /> 5 <br /> Contact's Telephone Number: i 4/49 ( c <br /> Contact's Email: /4"c-4:4in" A.`t i, f 4_ e,n/t e_ J / , f1(,I <br /> Legal Description of Property: 7 2; ✓,.- 1%.:, 'r"''' ' 1:.,/ >,'" /:..4'T E o <br /> FT <br /> Section#: .. /Town#: � ? N Range#: IR 7 W Towm of: CA.r+, t'' / o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> s <br /> Tax ID#(1-5 digit number;found on tax statement): � / 22 <br /> -3 --F <br /> Proposed Use of Structure/Addition: 6c^.--a i=F). f =t <br /> Anticipated Start Date: c-p /1• 9 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � = p <br /> a <br /> Building Contractor: Sewer Installer: /VA --i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , <br /> s <br /> 1 ,u-)e.k\ () C aCi40 N pe�'rn rtke 8F.e. r Survey z CI, <br /> NdSk.ZA1pn -to `klAcAtA a2 q ek e5e) bedro6rv\iafdl 50/ctie_ <br /> .3 Fee Rec: d`D D- <br /> q <br /> • Check#/ -'. et. <br /> / • `� m I 002�0/ <br /> Date of staff site visit: t. <br /> i a [nib.Is of site visit staff: <br /> tn <br /> APPROVED BY LAND SERVICES OFFIC • L: 1 se TE: / —1 d`Oc3- cA <br /> x CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a c„ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTo <. <br /> rem ali <br /> Transcendent: - m o C N r� <br /> Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 V w LID <br /> �{ <br /> a . uuu <br /> v <br /> I <br />