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LAND USE PERMIT APPLICATION —Burnett County, WI a g r <br /> Applicant Complete All Sections Below This Line 0' <br /> a 1 <br /> 0 l` <br /> Permit Types and Fees:(Please,check appropriate boxes) d N <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 "Q` d <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 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 4") ,---\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o P <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r • <br /> 0 <br /> Filling/Grading $150 Boathouse $500 D <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 iv <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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- g <br /> 2. <br /> z L <br /> Property Owner's Name: -14014A A S Ct+ 5T- ,,, , <br /> Property Owner's Mailing Address: I cx YE u...0,0 ZV -Q- f c,Act ii col 5��1 <br /> City State Zip = c I <br /> Property Site Address: 5'z- . K <br /> / <br /> Contact's Telephone Number: 6(9-5) +T7- I(p(. I Cid& C1,S) (4-35-0.7-7 4 n. <br /> Contact's Email: C;i--ge_r s 1 @ 1 NA,A41,Cowl II U , <br /> Legal Description of Property: ,;i- N)t I/ C(�dt.e �(y �rL�6�mac++" r<e(t��� o ao <br /> Section#: Zc Town#: N Range#: 1* W Town of: T,t^S K o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 1 6,19 c, <br /> Proposed Use of Structure/ ddition: �� cLc1A-(.k-j�-b �t�_ Ya <br /> H <br /> Anticipated Start Date: i/. I+j 'J2-1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor: IX ATT- "Ai -ti NI Sewer Installer: My'',SEPI C-KCA PA-Pc50 -i <br /> t <br /> til <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:/ / <br /> z CP <br /> ^ /Oa/..SE= s to l/se•-- h v04.0.1.vk.//-a/ 74- /e-Gi-574--574- G ,...5- (/ 5�T!O c7 CA— ---E....'. / ILl€ - lj er 7A L 7ai t c , <br /> FeeRec: /y)4 <br /> Check#: 2i 7LJ3 <br /> q <br /> Date of staff site visit: / / 29 2"/ Initials of site visit staff: I/7i.-- / <br /> i <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 2/V Z/ S <br /> 1 UPON APPROVAL: APPLICANT MUST POST COPY OF N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 2 RI% i <br /> Transcendent: - Page 1 of 4 huh <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2020 - m°c N <br /> y 3� <br /> RI <br />