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' LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 o <br /> Ca. <br /> Permit Types and Fees:(Please,check appropriate boxes) � <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �O <br /> / <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 Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i=. i <br /> 0 <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 /> i <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r-. gn <br /> 9. <br /> , <br /> Property Owner's Name: g 1� -, ' <br /> Property Owner's Mailing Address:Ag z!9 Ak L4k'E / ti 1480E- 14,1 1 50330 a `"° <br /> ��(( City State Zip E. <br /> Property Site Address: �C/c /f�NSCe' �4(e /��� w &IAwE $ 141. S"--ye3b c ,1 t <br /> Contact's Telephone Number: b10 —es36 "ci V: ? O • c <br /> 1 <br /> 1:Contact's Email: 1-x,Q AiL /AS 63- Q 4- AiiivG e, c2'/Tl <br /> Legal Description of Property: se L.II) 1 vikE Si-eteES Ac(s I 1 + 1(Jo� <br /> Section#: Town#: N Range#: W Town of: v- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number; found on tax statement): 'r` . ' <br /> 1145 Af5;-� POR ' <br /> Proposed Use of Structure/Addition:.�FTiJ� SEx 6iiil I <br /> i.. / ei4/?5 4se <br /> y <br /> Anticipated Start Date: AVA (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -e- <br /> Building <br /> Building Contractor: Ai/A-_ Sewer Installer: Al/4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 'I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z N <br /> x) <br /> ▪ Fee Rec:15 CE <br /> N Check#:35a..2 <br /> d <br /> Date of staff site visit: _ �.� 0 1n' .Is of site visit staff: .1\ky..,, <br /> trf8 <br /> APPROVED BY LAND SERVICES OFFICIA ,' - DATE* ��� � ` Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1 <br /> aj Guy <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? tiygii <br /> 0 <br /> co <br /> Transcendent: - Page 1 of 4 g i N o <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 3 1 Q <br /> WO <br />