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LAND USE PERMIT APPLICATION — Burnett County, WI ct <br /> -• b <br /> FN <br /> Applicant Complete All Sections Below This Line e <br /> Permit Types and Fees:(Please,check appropriate boxes) :'-' -2- F <br /> a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 G <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> ovt i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) _$100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> ;n <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. `; p <br /> *Communication Towers&Signs require a different apPliratian form;see corresponding application,and fees. ,.? II <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. m <br /> Property Owner's Name: 1e.n.f e \ `�` 0.A.r, c :C� 0\S O C1 56,6,�a0.k "2(-21� <br /> Property Owner's Mailing Address: �' rQt'tc �^ v" Vett) i5 1tS /4) 55/3 ( v <br /> City State Zip <br /> Property Site Address: o?Lic-] / f ro wSr;v i c^eni SW7a <br /> Contact's Telephone Number: cos _z - P a q O ° F A <br /> Contact's Email: <e-./1, rj\s or @ L FK:Sie. -5 M'T h- Cr -'o ' O <br /> w <br /> :9 <br /> Legal Description of Property: t A1.' 00-0 1?' D -.37 - 167- 3 y 5--IS " n a -030000 _ • <br /> Section#: 39 Town#: 7 N Range#: L W Town of: QC/t/L t E `� <br /> 00 <br /> 4. I' <br /> ' <br /> *Attach additional page if needed lengthy description O � <br /> attach a copy of the deed OR attach tax system property page.* <br /> P. <br /> Fax II)#(1-5 digit number;found on tax statement): 1 a 1-7 <br /> 5 <br /> t� <br /> Proposed Use of Structure/Addition: �ePe>Ln S �% 1�� C-' cn <br /> Anticipated Start Date:.\\ 'O)O (Nome/Cabin;Commercial Business;_L Deck;etc.) F <br /> Building Contractor�jo..,1 E.Co enpo r :CS Sewer Installer: '00.. '4..4°x11 c— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY tb <br /> el.t.. <br /> THIS PERMIT Is SUBJECT TO ALL CONDITIONS LISTED E -LQW(o, CS <br /> � 1 <br /> r' XR MO v G 1(�' Ca,�e3 Ick Cie c •CX(Qpt '-P f a 0O.S C'P z 1.1 <br /> b\J _II(112 ( (oma-Oa-1 ' z <br /> 7 <br /> 1> fNddt din 15 Prv)o !X � <br /> A) 3a <br /> f V o (40 �e iAtt. 07 IcOo S ill ett,7,1I C4 j 211'9. <br /> p& o �R�it� 11Ou32 needS �� b‹. c1i 1`e241� Fee Rec: LU� L� <br /> -� door 1�(, <br /> • Check#:Z <br /> Glx <br /> tr <br /> �- r <br /> Date of staff site visit q,_-<-3_ Tnitia ' of site visit staff: z <br /> c <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIA v DATE: /0 v d'c.-vo �^_' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �� c <br /> 5 <br /> T ° T � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - o C CZ E <br /> . 0. r. <br /> Transcendent: - Page 1 of 4tr a ro <br /> Burnett County, WI Land Use Application - Rev 6/2020 - 0 <br /> Laserfische: - o ? E <br /> a <br /> - <br /> z <br />