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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> _ b <br /> Applicant Complete All Sections Below This Line g - o <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> o. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 —D <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 Ll <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G � <br /> � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 j <br /> 11A <br /> Filling/Grading $150 Boathouse $500 t=. �r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. P <br /> 6 <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. -e <br /> Property Owner's Name: /t/710-41 S 4- L..iµe /2 .mac.�u //a t( z I. <br /> o <br /> .ri 1 <br /> Property Owner's Mailing Address: N`i`446 6.'s„47 tz,t '7 MPS„.-,a.,.c, 4.4,2 5-'17 5-l S <br /> City State Zip b <br /> Property Site Address: z-144 9, t,..(& to 21_ f)c....(pw y S`/Fs 30 P. <br /> 4 <br /> Contact's Telephone Number:-71--i- G Li- GO 6-7 vY -7 i'•3 o k”5.20`; o c <br /> CD <br /> Contact's Email: r_, µ w. a <br /> Legal Description of Property: Col ie-1- a P CL- ,gl/a C Lo-Z ., <br /> Section#: a Town#: y l N Range#: /S W Town of: Si,,,-SS <br /> cro <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> y <br /> Tax ID#(1-5 digit number; found on tax statement): a/ 0.2 S' I <br /> Proposed Use of Structure/Addition: Sk ee;•,hh Cviti..`r u -(1:.✓ Sfe/ u e— cn <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o x <br /> Building Contractor: Sewer Installer: b <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their 1/DC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes,manufactured Z V1 00 <br /> home addition and bunkhouses.** <br /> I <br /> - Jh io A— 51�e b Cs �� <br /> a <br /> t Fee Rec:*/S s <br /> , , , , d <br /> Check#: (� 3V <br /> Date of staff site visit: �� ���� �C�`�f' Initials of site visit staff: a i=cr <br /> =` <br /> APPROVED BY LAND SERVICES OFFICIAL: ia L.TeaA ?�`� ET <br /> --- 0,),, I <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF I i Of' <br /> 5' m <br /> rn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> N ! <br /> Transcendent: - Page 1 of 4 cz, <br /> rn. <br /> Laserfische: Burnett County, WI Land Use Application —Rev 6/2020 <br /> A <br /> b <br />