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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line 7• c VD <br /> 0- <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �- O <br /> Ne/ Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 G+ 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk ,Bunkhouse $250 ° v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r-. <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) ,$100 Permit Extension(1 Year Extension-Allowed Once) $100 c' <br /> m <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 5 <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. 0 k <br /> 0 <br /> z <br /> Property Owner's Name: Er K y --1 ElY,j)r i ' _ <br /> Property Owner's Mailing Address: 57c) 7 g C r I-f/ �) tI 4 <br /> City State Zip 5' n <br /> Property Site Address: 5 4 frit ___,,,p„,,7 w�, s$0336-) E <br /> Contact's Telephone Number: 7/S 7 7/ gerI/ •c a. <br /> d <br /> Contact's Email: CC <br /> Legal Description of Property: / 0 7Q <br /> Section#: /q Town#: ye N Range#: // W Town of: 641 L 4 AR/ <br /> t7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 6. <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): b$Q �. VD <br /> Proposed Use of Structure/Addition: s 70 t ct. C / r cam' f 0 R yoo Y <br /> Anticipated Start Date: it f p L �dK�C (Home/Cabin.;Commercial Business;Bedroom:Deck tc.) 3 C7 <br /> BuildingContractor: t VIAL:1:4 h I Mwi <br /> NSSEAlS Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> (1--f.)-j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I m ali S4 zck z <br /> NJ - tiw t <br /> Fee Rec: L50_63 <br /> Check#: tZ4y <br /> Date of staff site visit: 9/?I i j�l ' d <br /> ?-1 Initials o site visit r : Y <br /> APPROVED BY LAND SERVICES OFFICIAL: ear_ ,/, DATE: Tb 1,t) —„c.__, <br /> UPON APPROVAL: APPLICA i MUST POST COPY OF N m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> r 0 (7 V1 <br /> Transcendent: - a o c <br /> Page 1 of 4 �,a C <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2019 < 3 <br /> dtn <br /> 4 <br />