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LAND USE PERMIT APPLICATION—Burnett County, WI a g b <br /> J tJ <br /> Applicant Complete All Sections Below This Line ° o <br /> CD iPermit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 t O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> Accessory Structure(Comme�aal/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °°n <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r t) III <br /> 1 <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r. <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. i F <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- 3 <br /> 0 c <br /> Property Owner's Name: -.)C,.'-c\i L- ,s l c C,_ .': . -r, <br /> 8 <br /> Property Owner's Mailing Address: A=--7_S-X, C v C.i c.` ! . 1\07)t VAI k.1 k' <br /> v S V <br /> .r $ <br /> City State Zip . <br /> -�- <br /> Property Site Address: 1 rt y i 11 t,t G7 <br /> o J <br /> Contact's Telephone Number: '14..%`, ''S 1 ( I ") <br /> o. <br /> _ o <br /> CD <br /> Contact's Email: n-\c cF.:„i ,\\C.M Ip S .�L CIsivv„, i ,C%.;.�1 ro <br /> J <br /> Legal Description of Property: C)C)\if 1._.,,,__, - 3 00 <br /> Section#: ' a W Town#: '14 N Range#: \ Lti W Town of: S.t ,SC; go <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): r 1 l O v) <br /> Proposed Use of Structure/Adition: S h ed .- x <br /> Anticipated Start Date: 9 /C' 7] 1.,-.),)4_2, <br /> (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) t7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO AL CONDITIONS LISTED BELOW: <br /> she . N --c or h(AAA ck-6- -7(3n z <br /> .-./34 D- .2 ✓ , Fee Rec: Imo62. <br /> y40*...Check#: 40*.../� <br /> m <br /> Date of staffsite visit: In..--doo t ' Is of site visit staff: Y------' <br /> APPROVED BY LAND SERVICES OFFICIAL VP"- DATE: ?-;:>)-0z ,---------7- <br /> a <br /> v, <br /> '27D-OO r4 <br /> -- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF T, 0,Cr3� 1 W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z - „- � <br /> 0 o IV <br /> Transcendent: Page 1 of 4 N yIV <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 r, 5 <br /> CM <br /> S `r <br /> t �- <br />