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LAND USE PERMIT APPLICATION—Burnett County, WI a 5 <br /> b <br /> Applicant Complete All Sections Below This Line 0 o <br /> r <br /> a w <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ''r ,,,:.Oci <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Z <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r� <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn <br /> a <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> lir <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. 1. IIP <br /> // z <br /> Property Owner's Name: Lc,.f t y be -i,-- .ef<Y ,.� - P <br /> 6. <br /> Property Owner's Mailing Address: ,.�. 0 6 3(.-/ /10,i,,es 4,c4..f Lehi);de t/'r1U g S v l/! <br /> r, City State Zip 0 <br /> Property Site Address: ..2�7 A <br /> 1 / ,.,,Sc,c rs.-t �(,c RLd. C :..4, f y t uJ I _.,4- <br /> Contact's Telephone Number: 9fS 2.^ -� a. <br /> g3 336 �� <br /> Contact's Email: DO./r e �yieux.j. c C../.4.07C../.4.07Legal Description of Property: s - e. c,;-CSNas <br /> Section#: 6 Town#: .() N Range#: /y W Town of: Sc_,, d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* E. <br /> r, <br /> Tax ID#(1-5 digit number;found on tax statement): /'%S j rn <br /> Proposed Use of Structure/Addition: ic..'. y -i <br /> Anticipated Start Date: 454 p (Home/Cabin;;Commercial Business;Bedroom;Deck;etc.) ° 5 <br /> Building Contractor: (.,r,:c,"Pr.1)c.7.14- Sewer Installer: /4,4 ic ns S4.,..d: 6tc.,_ t/ �. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS1LISTED BELOW: <br /> 01 <br /> ® f) ROW V,O`�-- -).‘a.1(A z 'VJ <br /> - Fee Rec: t .-' -'!' <br /> Check#: <br /> ^ � J \1 — <br /> V. 0 v <br /> Date of staff site visit: • Ia a40d" I -als of site visit staff: at <br /> APPROVED BY LAND SERVICES OFFICI : � DATE: l � m <br /> n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT s m z <br /> Transcendent: - Pae 1 of 4 W r <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 <br /> rx. 0.,,...— a_._..a, <br /> V a, Y r] <br /> A <br /> LTJ= <br />