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-• ' LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5' e c <br /> o. ' <br /> P <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `' U\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 $ C— <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w �\ <br /> R. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r... i <br /> 0 0 Ilk <br /> Property Owner's Name: �n,m< ; ¢- L aura (Al, c-c‘ck <br /> Property Owner's Mailing Address: o)g 19 1 5 J otI n 5 0, 1_,,k,„ ‘2J WZ11:17e r (,t)1 ,sY 9i j E <br /> '---- r j1, City State Zip = � <br /> Property Site Address: ' $191 S JOh n.s c n Lk, 12 d E I <br /> (, <br /> Contact's Telephone Number: g Ia?- 7 q9 - S'6 4 <br /> f d <br /> tidos-Contact's Email: (,Jor c..<s J E !i V e- . C o,,,-i FIT <br /> Legal Description of Property: 0 ao <br /> .. <br /> Section#: 013 Town#: �0 N Range#: /1, W Town of: Uc,k (c;,� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): /.i 6 I 5 cn <br /> , <br /> Proposed Use of Structure/Addition: ST®r‘a 9 e_ g x /c pop ' <br /> Anticipated Start Date: /0-I-a0 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 0 <br /> Building Contractor: G t 4 H-t c tl rPrerh,'e r- Sewer Installer: <br /> AREA BELOW THIS LINE FOR LANDS RVICES STAFF COMMENTS/CONDITIONS ONLYy <br /> A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: k-I'' <br /> z <br /> ) <br /> Garoz, wai- 40 k URI egr YZhtdtitat4 hab`+a biA,.. <br /> Ai Atilara i wilhik 3cIR or OHWW is pnokiloilc4 <br /> • <br /> .. Fee Rec: 1511E? <br /> Check#: 1 ea-73 <br /> Date of staff site visit: /202.0 Initials of site visit staff: r <br /> 8 <br /> APPROVED BY LAND SERVICES OFFIC - lip,. / RATE: 000.2,0 < J <br /> UPON APPROVAL: APPLICAN UST POST COPY OF ri a U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 2 m N �1 <br /> y o -P- IJ Y U P <br /> Transcendent: - Page 1 of 4 w o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 r Q', <br /> 3 gra <br /> � ~ L ) <br />