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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line 5 N <br /> o <br /> Permit Types and Fees:(Please,check appropriate boxes) <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 /> "' Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 c) 0--- <br /> ' Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse <br /> $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 1� <br /> I 5 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o <br /> E ---.\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r = <br /> z AP <br /> Property Owner's Name.` �ZySOvt 1 (Vn4JJ e <br /> �j p <br /> 1°51 C -5'-??'dAve?_ 6Tr�& k� ' / ,i G <br /> Property Owner's Mailing Address: _ <br /> m G City State Zip <br /> Property Site Address: I V °Cf? Kr>—f9 F- it C/ ,,fC vk - 5 �7,A. _1 <br /> [� o s <br /> Contact's Telephone Number: C-(7 7 '1.)- 93? <br /> ,-_,.. <br /> Contact's .c-.- <br /> ...Email: ' t 19 PA`( ? &Ye+ 4 t'v �"'"� <br /> Legal Description of Property: I <br /> w N ) e W 1,) e �S a <br /> l6—'7"- o` ' �� <br /> Section#: S t"1 Town#: i"' ad N Range#: W Town of: Da...,-e/s <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number; found on tax statement):- a�/O 3 i� <br /> Proposed Use of Structure/Addition: J tel o' ") S ke CI VII-$;v I-f 1 ' t x $ I,,, -i <br /> £ x <br /> Anticipated Start Date: 7/a-6/hZ (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> ,c;,— <br /> BuildingContractor: N - w <br /> Sewer Installer: <br /> 310 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY • r <br /> D. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 ` w <br /> Muir (f0V__ kAtom Rad3 A-Q.-Via g z <br /> 7. <br /> 1 <br /> z Fee Rec: CPQ <br /> r Check#: <br /> � 1 � <br /> R)(--- <br /> Date of staff site visit: -a nitials of site visit staff: r <br /> D <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICI L: 6A E: 7-- 5--a^2.f3 % ' C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF j $ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 0 1 1 <br /> r w '. <br /> O 6x, <br /> Transcendent: Page 1 of 4 g z N..) c <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 <br /> o i <br /> 3 <br /> z <br />