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LAND USE PERMIT APPLICATION - Burnett County, WI g <br /> Applicant Complete All Sections Below This Line 0 CD Io <br /> a <br /> C7 <br /> Permit Types and Fees:(Please,check appropriate boxes)', „ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> ,f_.°, -k <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> [X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> K Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350r. <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> I <br /> *NOTE:After-the-fact permits(permit squired 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. i-, ( f <br /> o - <br /> Property Owner's Name: S\\no..,r-e:SC- U`-- C-- o <br /> o` <br /> Property Owner's Mailing Address: 2-1-1 5 `h U.c Q��s�e W�- S-�y3 .o <br /> ' <br /> City State Zip 5 n <br /> Property Site Address? V_o f s \-_,N 9 Li Z' t„3 0 7 `) <br /> Contact's Telephone Number: -1( 5 - `t- I - o I to 6 (� a F C <br /> a <br /> C'J? - Iq- zl o <br /> Contact's Email: _se,a�.-s_s a\--- 3e 1 <br /> Legal Description of Property: J o <br /> Section#: 05 Town#: i-r0 N Range#: 1(o W Town of: Ac.\a..,d\ <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 /> o' <br /> Tax ID#(1-5 digit number; found on tax statement): 3 0 07 <br /> Proposed Use of Structure/Addition: w-\\ .a s / (AAA", D v Ce_ 5A,14 o <br /> Anticipated Start Date: t,'I(7/3-02 a (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) = C7 <br /> f ., <br /> Building Contractor: 6rdcz-7 tiA o,,,,,-\-r,o{-.o,.. Sewer Installer: Poeu.,-,g <br /> -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLX i‘ <br /> THIS PERMIT IS SUBJECT TO ALL COND T ONS L STED BELOW: <br /> S1ai .c ku.WIa u it�: l^e n z <br /> pv <br /> b iLec6n n E-C-± Pet IN -k- �.i rd T-or `�h haus ' <br /> Fee Rec:3 0 <br /> Check#: <br /> , \1\\(----' 5 <br /> tz <br /> Date of staff site visit: -j �I, �'tials of site visit staff: V <br /> %\ <br /> APPROVED BY LAND SERVICES OFFICIA LI: on <br /> _ATE / ':. <br /> 1 J Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a I l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT co c <br /> . W . r <br /> Transcendent: Page 1 of 4 �_ r..., o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 m o <br /> (Z Z 1511 <br /> CA <br /> LLJJ <br />