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r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> a <br /> o. <br /> P <br /> Permit 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 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 = D <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. s5 0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. LI <br /> *Items not listed above will be treated as accessory structures,such as: go <br /> s:pergolas,landscaping,etc. o 5 <br /> Property Owner's Name: 1111 Y` es <br /> scA <br /> rr <br /> Property Owner's Mailing Address: `��a L'( S ''�' N. lectA '`�'iii w f Ii=. <br /> `Q q %}') ^, tty t^ State Zip �� � , <br /> Property Site Address: 3E�U ! ' r ' y2-S le � /1� E ` <br /> / -7g30 o <br /> Contact's Telephone Number: �/O( — (QQ a c. <br /> Contact's Email: R2032, &?/@. C f0 1Q 1 T/,fie e f <br /> Legal Description of Property: o <br /> Section#: 0 ( Town#: LLt) N Range#: i� W Town of: cjaCL-51)^ cm <br /> t7 <br /> *Attach additional page if needed for lengthy description OR attacch``a copy of the deed OR attach tax system properly page.*7 <br /> Tax ID#(1-5 digit number;found on tax statement): 7h6 v) <br /> Proposed Use of Structure/Ads ition• <br /> la.x /6 `fid (otc1 ff ciso m) o <br /> Anticipated Start Date: 5' / - „ d S ,r/,,ii.bin:Commercial Business;Bedroom;Deck; c.) 1 e <br /> Mall' )nS'5/1�Pt-- <br /> BuildingContractor: �� Sewer Installer: <br /> L,I• iC. • i <br /> ,f <br /> AREA BELOW THIS LINE FOR LA 1 SRVIC S AFF C O MMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> p p t E�'CWVv\O V\ - t eta Y\, z <br /> .- Fee Rec: 1SD� <br /> AY---- 5 Check#: liio(,`J <br /> Date of staff site visit / <�"` Initials of site visit staff: x <br /> APPROVED BY LAND SERVICES OFFICIAL:`-"`- ��'' �--- DATE: ..-?I -73°a-C) �'�-^�"=�-' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF am g�, 1, r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> -rt - n d <br /> D O C <br /> Transcendent: Pagem p <br /> 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 - _ <br /> e <br /> mm _1!u <br /> 0 <br /> ro <br />