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• <br /> LAND USE PERMIT APPLICATION-Burnett County, WI <br /> LI <br /> Applicant Complete All Sections Below This Line 0 X Y <br /> . a LIPermit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 )( Addition/Alteration to Dwelling/Principal Structure $200 'i— <br /> 1(3 <br /> ' Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> _ t� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> PD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 ..— <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c- p X <br /> Filling/Grading $150 Boathouse <br /> $500 r� •� <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 `n <br /> m <br /> 0 <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 /> CD 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g t <br /> 1cn Nik 012- 6tL1o,4 -4 �lL� Ielk:. z <br /> ?-- <br /> PropertyOwner's Name:— I �/v ° F , <br /> Property Owner's Mailing Address: l-7 C'rif i :q i4 S M2. 01 tf() 'a I ‘1-1 , <br /> Or <br /> �� / Ci State Zip <br /> Property Site Address: .1-'5-_,) 5 r,,( 1 £Tz/ A— i )SS 1 j 5-y713 C <br /> Contact's Telephone Number: a <br /> Contact's Email: (,� X1 Q� <br /> Q �.. . et) ti_.ca,_ visit- d 16 <br /> _ /6 -/7 x-D 71 / , <br /> (-guy Description of Property: Pt L . -J "3 E A4A-1 (.iviacr- o qi <br /> / r` = • <br /> Section#: (X Town#: 3q�1N Range#: ! S W Town of: 5374/VD L-1 1( g <br /> d <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): /140(- S6.) 1. _ 'l 7 T <br /> Proposed Use of Structure/Addition:pftwx1 V Pt-Z 712- aH H <br /> Anticipated Start Date: �) F <br /> p . 1 � 7 (Home/Cabin;Commercial Business:Bedroom:Deck:etc.) p <br /> Building Contractor: 5F- Sewer Installer: v -I <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .�, <br /> Qs/ope s 'iM o' cCwe411H7 41/d yQ ye 4 6e- 6i%/z ea41 z <br /> e.e. (DAil cove ee it) Ye-mii* ruN-O•6‘c f.1 <br /> ticNQS O <br /> Ore cow%6�'Hee. 4n4Cbor• c. Ilne_. 4 �s so it . 03 . ,00 <br /> ( / Fee Rec. Cy <br /> /S N 90 7 v_u/yA /v/e.. G t41�/o �, y Check#: P (9 <br /> Date of staff site visit: (21)G/ZInitials . -site visit staff: /'/Q 17 r//�7t '� D <br /> / / 1111161 (1 Z <br /> APPROVED BY LAND SERVICES OFFICIAL: ,6.,...a DATE: //Z6Z/ `T;01 —,1.-=_- <br /> UPON APPROVAL: APP ' ICANT MUST POST COPY O y a <br /> -1 cn co r. 1 <br /> SIGNED PERMIT APPLIC_AT_IONIN PLAIN SIGHT z zg.P — 1 <br /> Transcendent: - ..j,,,, j 0. R''':--3> c' <br /> Page 1 of 4 --...Q :7, <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/201 <br /> 0 No- / e fui by of s pee s4noYo 4 = 15i1 <br /> y ,4o1 sibi'N�, IA)"A /Sbe1rvo 3 bea/roo.� s, (, <br />