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a <br /> LA 7-F <br /> LAND USE PERMIT APPLICATION—Burnett County, WI ro <br /> Applicant Complete All Sections Below This Line _ • O <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> a <br /> ▪ o <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 /> X,Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 I o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 1 < C) ilk <br /> Filling/Grading $150 Boathouse $500 <br /> O 116. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1 V <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. • I <br /> Property Owner's Name: 7—Mira...6 Lu,Kr � z <br /> q rli <br /> Property Owner's Mailing dress: 1. - I '2_ Eve/IA i' GJ 1— u ; La vi,;-e� MND 5550 -H X. <br /> City tate Zip ' <br /> y 9 S a,ct lei/1j Pct, ) 6�ra«fs burg v I 51 sJQ <br /> Property Site Address: , 3 <br /> Contact's Telephone Number: q-6-c:2— 393— ' rs- <br /> a <br /> Contacts Email: /l,(k y cuttriti.ct fll i( �'VtGu I • cOivt._ B <br /> `/ n <br /> Legal Description of Property: <br /> N: -uSection#: 3- Town#: 9 N Range#: 19 <br /> W Town of: 67r cut,7‘,s bU 1'9 <br /> `Attach additional page if needed for lengthy description OR attach a copy of the deed <br /> �OR2attach tax system property page.* d <br /> LT <br /> Tax ID#(1-5 digit number:found on tax statement): , iG � f//I J/ `7' <br /> J� cz: <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 02/C3) ,o.e (Home/Cabin:Commercial Business:Bedroom:Deck;etc.) E x. <br /> Building Contractor: ` ef,�4�� Sewer Installer: ------ --iAREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: cJ\ <br /> IJP— f c V\uylt oz,Y. .b -6* r' z !• ,- <br /> x <br /> 1 [ <br /> Fee Rec: e <br /> Check#:_(� <br /> j <br /> Date of staff site vis'Si. /�`�R7i I 'tials of site visit staff: <br /> VA-----**------- ��1 ��-- <br /> 7. <br /> APPROVED BY LAND SERVICES OFFICIA DATE: J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF = Q <br /> N35 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 z <br /> o o S r <br /> Laserfische: <br /> Burnett County, WI Land Use Application—Rev 6/2020 _ � ro <br /> `'' Q <br /> 1 <br /> z <br /> z ��ll1? <br /> IYI <br /> Lam-:) <br />