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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line Q.E *d <br /> y -e e tom <br /> Permit Types and Fees:(Please,check appropriate boxes) OQ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `.M W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �Y f <br /> ,1( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 10 �f <br /> V7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <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) $100 c' 1- <br /> A <br /> P. <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. , P <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. r- i. k <br /> Property Owner's Name: Il (,L A-10E �jt% - / oeiA(7�V r.1 ..., .T, to o rnr• <br /> F. <br /> Property Owner's Mailing Address: 7. �3 tt�/i;i Lai , ,Lui L- .)---iii: 1" <br /> City I State Zip 67 <br /> Property Site Address: A,tn, 413 Jic-1-Z.. E <br /> o N <br /> Contact's Telephone Number:(pc! - 3 e g / 3 a2.p g, \ <br /> Contact's Email: kkii'k T hif� c'r% �wlC Gc.S�a 'vl.e <br /> Legal Description of Property: r Q o (T, <br /> Section#: Town#: . ` N Range#: W Town of: <br /> tz <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* n <br /> Tax ID#(1-5 digit number;found on tax statement): ..i 3 q,3 ,P, ,„ <br /> Proposed Use of Structure/Addition: .mac (ton i 4.1 a e _ o <br /> Anticipated Start DateI <br /> b.ci u�'t 2b t7CZC (Home/Cabin:emBusiness:Bedroom:Deck:etc.) ° Cj <br /> Building Contractor: :i r 04, 1t:r c`;! 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 /> ii&phc Sti+cw > s+ ‘Oe.. w.44' x4KaCVScrv4cd bit i2/i/Zo2o or Cauffert <br /> Witt be iSSucae. 1 <br /> it &vele lot fo be ubaa2 Ar d ttuutt4 babrf lyo t. P <br /> Fee Rec: __ <br /> 7, Check#: Ln Ti <br /> d <br /> Date of staff site visit: 0/2026 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIA . DATE: 84/2030 <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF Guy <br /> D <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> MI <br /> Transcendent: - Page 1 of 4o c`' <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 3 <br /> J <br />