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LAND USE PERMIT APPLICATION—Burnett County, WI a 1b <br /> • <br /> 53 . N <br /> Applicant Complete All Sections Below This Line 5' c <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> ~ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 tr. , <br /> 9 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � ; <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� PO <br /> Wall/Sidewalk Bunkhouse $250 °< O <br /> x Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 rN. <br /> Filling/Grading $150 Boathouse $500 0 S <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. , <br /> :# <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. c i t <br /> p CUY").6 Rona(d P P . ` S'�-- ( Pr ur) o <br /> Property Owner's Name: •d- � WL tJ t -r, I <br /> -11\ <br /> Property Owner's Mailing Address: 130 I (', /' !V 1 .5)/ 5t•av I m/J 554 7S b <br /> ICity State Zip 0' y �� <br /> Property Site Address:317(1 e®Url">tt r O{ pi r aitioS7,,,�1 , bur ,�c{6'93 " P <br /> Contact's Telephone Number:f (05/ —3-Sti `— 1 0/ 0 d • •I <br /> Contact's Email: a c-144 U CA' w\ 0 it� ---7(0 @o mai ( d IV) <br /> Legal Description of Property:ID CL G Oki LOT 1p 7-Ese.., DOC 357 34 cpoo <br /> 4 <br /> Section#: Town#: 110 N Range#: (5.- W Town of: 4 -s 01" C <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Et.. . <br /> Tax ID#(1-5 digit number;found on tax statement): 5(. 0 cn <br /> —3 --1 <br /> Proposed Use of Structure/Addition: Ptt t© f <br /> Anticipated Start Date: ( ,URJJ . I (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° CJ <br /> Building Contractor: Sewer Installer: H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> IDFeeRec: 1/c3 <br /> \j*„....._ <br /> y Check#: ( �' <br /> rz <br /> Date of staff site::::7-----`g—doc)-0nitials of site visit staff: y <br /> ^/� z <br /> APPROVED BY LAND SERVICES OFFIC A u c fP,." ��7� <br /> �� �J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFr <br /> iitil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z z= r- <br /> Transcendent: - Page 1 of 4 p c CO of <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 �a cri r9 Q <br /> o <br /> yyH <br /> �c—i-2) <br />