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LAND USE PERMIT APPLICATION —Burnett County, WI cr i i <br /> Applicant Complete All Sections Below This Line 0 CD o <br /> 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) I ..O <br /> 31 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � Ul <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> jC Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 I g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � )•.> <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 1 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 i .,t <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 /> CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g <br /> /� LLCA, R1C.+vt CSL .`xi/�� ° I <br /> Property Owner's Name: A �AT IP <br /> � <br /> Property Owner's Mailing Address: 8((Y i RE MO R.61- te)e ,5 Cil -l- SL/&9 '3 <br /> City State Zip E. <br /> Property Site Address: S A C I 4 <br /> c <br /> _ y <br /> Contact's Telephone Number: (o i? — Ljv — 44 3 3 S _ • a <br /> Contact's Email: O ALLEX) /tit i4 I c-. 6- M/=E/ _ e C0`' co 4 <br /> Legal Description of Property: L(��.Z � �l S S l IrvZS Pc? 7 e6-4 A.)#932go <br /> Section#: 00 Town#: *1/0 N Range#: /(o W Town of: M E EA1O rt.) qc, <br /> P. <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 10 C' <br /> Proposed Use of Structure/Addition: 6 <br /> izA ,cE 75Tagt4C., C 1 a <br /> Anticipated Start Date: 'Wj/ia c X c (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) GI <br /> Building Contractor: Sewer Installer: 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> \\JO-t- 1----1-- <br /> Fee Rec: c7 <br /> Check#: cOnb <br /> I\A\1--- tYi <br /> Date of staff site visit (d----(9--0?-6) Initials of site visit staff: <br /> 6 <br /> w <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: --) ;� x <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF tri acn <br /> a � -. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 .o �, � <br /> < mc cn <br /> Transcendent: - Page 1 of 4K <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 < ; TR <br /> ' ,moi <br /> ,...,-3 <br />