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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line '5� o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) b <br /> CP <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " .-S) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -C O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 J <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G1° P <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .. <br /> Filling/Grading $150 Boathouse $500 <br /> G <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> m <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r gi <br /> arr 0 Z ` <br /> Property Owner's Name: di kilt r ' ZX '% % , 1111_! lb `L_ <br /> Property Owner's Mailing Address:-74ja ( Pe_p_:+-.51-- b ry Ly r 3,2,1.' In ia. <br /> �itzState Zip <br /> Property Site Address: 7G �j 5'—T J(�y VO 1 LJ r 'j <br /> Contact's Telephone Number:i ir-�'3.3 - [�n�' o a <br /> Contact's Email: fl r 1 -min r([,r y-1 ( , c,�-) <br /> _j ? <br /> Legal Description of Property: 41 4 ` I 4 1 I_-a a • t_ .i (J I 9 <br /> • <br /> Section#: Town#: N Range#: W Town of: w <br /> CI <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> Tax ID#(1-5 digit number;found on tax statement): o' a,°1Lf { (00d 3Q/8 (b-3�) o, <br /> Proposed Use of Structure/Addition: t-i-1 c2 � �?� � <br /> [� � � I� <br /> �` / o - <br /> Anticipated Start Date: (Ho e/Cabin;Commercial Business;Be om;Deck;etc.) ° d <br /> 4 , , <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r-, O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1)., <br /> 1 z <br /> = Fee Rec:..2(� 42 <br /> Check#: 501? <br /> o <br /> Date of staff site visit: A\mac' .. ni 1S of site visit staff: j <br /> \j\ ----- mez <br /> APPROVED BY LAND SERVICES OFFICIAL1ATE: ? c, P7odD ___^_J <br /> 11110 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF „ c, ., n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z �' LiiiiI <br /> Transcendent: - Pae 1 of 4 w = ns <br /> Page ca <br /> n = Cl <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 <br /> 2 Uuu <br /> LTJ <br /> 3 , <br />