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• LAND USE PERMIT APPLICATION-Burnett County.WI `� <br /> E k4 <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Please,check appropriate boxes) a.. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d 0,4 <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 J y <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> e <br /> Driveways/&Campground Structures $125 WI State Statute 59.592(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100_ Permit Extension(1 Year Extension-Allowed Once) $100 --) <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 appfi ation,and fees. <br /> *items not listed above will be treated ascar ccory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 0\'.:1 VA4 k1.1eig- <br /> o <br /> Property Owner's Mailing Address: A/0503 L®qa%. La111L Sjcowr- vi; s��t $ t-- <br /> ity State Zip -a <br /> Property Site Address: a b 52,5 L. 09 on La we I =poo ft p- e. vl <br /> Contact's Telephone Number: 715 435 ford VS ° ' <br /> ea <br /> Contact's Email: ` <br /> �A4641 / lN4e-K1Ct ® Q mail LOM a <br /> Legal Description of Property:4PM/ 07-02.4.2.^3Q -14-11-3 eq--ate-VS 00 a <br /> b <br /> Section#: Town#: N Range#: W Town of:,2u Sk t . <br /> *Attach additional page needed for lengthy description OR attach a copyof the deed OR attach tax system propertypage.* <br /> 0. <br /> N <br /> Tax ID#(1-5 digit number;found on tax statement): /SS ZS <br /> Proposed Use of Structure/A dition: .0 PQ la t Pg Mit t Sk i forbid r- o strn y °-.3Anticipated Start Date: L p � ( ( Iome/Cahin;Commercial Business;B Deck etc,) Q "e <br /> Building Contract6tti/t /ki ft t o Tr.0 Si4;Install 71O/ . it/46164/ )10 U3 -1 <br /> MME <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COTS/CONDITIONS � 'ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: E <br /> • <br /> **The applicant needs to contact their LZ>C Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, <br /> homes,manufactured <br /> Z <br /> home addns,and bunkhouses.** ffrrr,"''000r .or % <br /> 011 <br /> 1 <br /> ' 4ruAc +eS on *;s pSaeCC0.ft Iiape1 <br /> `‹.,� �r�s <br /> 51.e °r hAb �- 1 <br /> C) meek Pal 5e. <br /> Fee Rec:1 .0 <br /> Check#: j <br /> 7/7/ I- <br /> Date of staff site visit: Initials of 'te visit staff: r/�, <br /> x <br /> o/APPROVED BY LAND SERVICES OFFICIAL: XPDATE: 7/8/02/ t$3 <br /> UPON APPROVAL: APPLICAN '-4VST POST COPY OFCiltn t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 z 2 w <br /> '< . 0 O <br /> O <br /> Transcendent: - Page 1 of 4 . ry <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 12/2020 3'` 'r' <br /> g.4 <br /> x <br /> b <br />