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LAND USE PERMIT APPLICATION—Burnett County, WI c g b <br /> E: . <br /> Applicant Complete All Sections Below This Line 8 w L.o <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 411 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 N) q <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 -t=• <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100F. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: /I Al flu C ke pi <br /> // o0 <br /> Property Owner's Mailing Address: C? (rr lS !ht 6H,,/"tl �'i VeC C/ S t rei-, �i 5 /t 2 a <br /> / City State Zip a: <br /> Property Site Address: 6(II$ f /,c . <.c/1 g cxt c c <br /> 6 <br /> Contact's Telephone Number: C Si- o? /V--q7e;/ a <br /> d <br /> .f .t 7 /h „I • L <br /> Contact'sEmail: I �t 3 36 0:rs-% <br /> Legal Description of Property: P,rt 0 7 '0/ 8 -,).--3 i"'/ .)7-.S is -dos 0/ .6OO\ aro <br /> Section#:,?-7T Town#: 3 I N Range#: ji,,,.cd W Town of: /tll 2/t c,A ao <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): f a Pc 413 , w <br /> Proposed Use of �Structure/A dition: 44e,h,.„ C.' • r!/Q5{-, ab-it . <br /> Anticipated Start Date: 7 i 3/).0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d <br /> Building Contractor:Ch`,.4 6 t ';ie},,$ Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> .r e .t,�on f- hu i\ hob)-I- on pz <br /> .- Fee Rec: 1.(613 — <br /> Check#: Sal l <br /> Date of staff site visit: ✓'` I tals of site visit staff: , <br /> E i` JI' <br /> t ,� / O t t=, <br /> �- <br /> APPROVED BY LAND SERVICES OFFICI C BSE: co Efil <br /> a�. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF VT z 0 <br /> a.e <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 1 i 0 <br /> = <br /> Transcendent: - Page 1 of 4 • t=' 1� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 <br /> l. .) <br />