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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line w o <br /> a- <br /> Permit Types and Fees:(Please,check appropriate boxes) aR <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> rwoCommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc` $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alterationto Bunkhouse $150G77) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 er <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' <br /> Filling/Grading $150 ) Boathouse $500 , <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 I a <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... <br /> b <br /> Property Owner's Name: t'\naf ew" J 0+.0^4-- c)e.e -Ti <br /> Property Owner's Mailing Address: 37 2.c1S -1,)-1 1 rt".\ k 6 f,k•N e-1#3 S 505 b . <br /> ` n pp City State Zip 6. <br /> Property Site Address: 2_1 6 Z f.., -,ca--( l \c.,,, \I,Jt k) <br /> Contact's Telephone Number: <br /> G \ Zoe S2-1(2) <br /> C a <br /> Contact's Email: CNY\t ) P E'e 9 4 C�`J t`^�`\ ' Low,‘ <br /> Legal Description of Property: P\.a\-0- 5 tc, St 7 G tem , L o'r -7 N .o <br /> Section#: Z-S Z. Town#: 41) N Range#: I 1 W Town of: 0�-•.•to. <br /> O. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 5_ <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 2-S S Z 6 <br /> Proposed Use of Structure/Addition: G C)c1/4.\-\r‘o,i ye, ° a <br /> Anticipated Start Date: # S i i c 120 ZJ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> Building Contractor: Com".\ C Sewer Installer: (1D''vz— — y <br /> N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY !.. <br /> V1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V1 <br /> W1 LAsi- 1lo/u2 to.4-Aiou5e_... clgv'eeN•�r,H* �tr. - 5. z \" <br /> 2 - p��..-aid -eye-?It CIOo $ c( 1,✓ .eL $mays l., ,�) m <br /> �►c v e �O r�rtti+1l'f5• C�Hs7`Y�ty o b�7 wee-iii 2,012-- an 2.o0 <br /> p&vp,A11,� �� O 6�q/N , 1 I II Z ao. 4 COt.✓� (JQN� <br /> exA q i v to /l'J" lid e, Alb2, l+il Fee Rec: JW w <br /> 3 I D i 5 ca Check#: 8S <br /> s/)/ZCZD- )--k o O U\y_____,Date of staff site visi Initial f sit visit staff: t- <br /> (p 07 zoza. i`'7 � 7 0 Z0Z0 6 <br /> APPROVED BY LAND SERVI S 1 FFICIAL: �E• // '0 = C� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 11 a D =(� � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o Z g -1' <br /> �� <br /> Transcendent: - <br /> Page 1 of 4 1 y <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/2020 ^ Q <br /> mIiiiil <br />