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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Applicant Complete All Sections Below This Line tiv.CD o <br /> a. $ <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial Industrial Structure <br /> / $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Ol <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 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 c' <br /> 0 <br /> 0 <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. g <br /> � z <br /> Property Owner's Name: i t1`�n`A`2"I L 132_0,,),J1 STc '(v . B6 fN E-T? <br /> Property Owner's Mailing Address: 2 Z tc-3 5-TCr-200C S TO- -Ts UttCE-t Mt-) '4'6(« Q. <br /> --'45)? ��yy __ ����e City State Zip E. <br /> PropertySite Address: ^'� � V��IC ��i�BS��1-- <br /> 7-Z- <br /> � <br /> �iJJ \ C <br /> Contact's Telephone Number: (06 (. -2G 0 2-clgq C STE`FJ 0 a <br /> I <br /> Contact's Email: S'� eU� Q d A S-tI~ <br /> CD <br /> Legal Description of Property: SEE- f A C(-(01E/•./-1- (10 <br /> Section#: Town#: N Range#: W Town of: IC% w <br /> d <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): 1 g t i 61 (- <br /> cn <br /> Proposed Use of Structure/Addition: cPRF\GE ! 5 i CSP GCS- 1 P,o -- ' -:.. ,,-� 0 . <br /> Anticipated Start Date: A.v,6ut S Z ' _0 .O (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) I = 5 <br /> Building Contractor: '-i.4--�`rke&J i `F, . 1'= Sewer Installer: PJ [ I <br /> ' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 4, ; <br /> A}O± ir��may t`1\fc\-- -A--1 Gl\ <br /> l 1 <br /> 01!© 10 p p\&v\ <br /> Fee Rec: <br /> K. 0 k___. . Check#: <br /> -&-- <br /> Date of staff site visit: i Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIA : - DATE: 7-/6- `--. 0 <br /> 6,,, <br /> m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a _ <br /> a < , r— <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o a <br /> Transcendent: - Page 1 of 4 0, N c4 <br /> 3 • c) <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 5' 2 RE <br /> a <br /> H L.C.-41—)/ <br />