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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line ?it- c 7. =� <br /> o ..7 <br /> Permit Types and Fees:(Please,check appropriate boxes) w (� <br /> XDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '' �? <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ���" EO <br /> - Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° CTj <br /> Driveways/&Campground ,0 <br /> y Structures $125 WI State Statute 59.692(iv)Structures $350 t- <br /> Filling/Grading $150 Boathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100_ Permit Extension(1 Year Extension-Allowed Once) $100 d <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 4 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro r, <br /> *Items not listed above will be treated as accessory structures,tsuch as: <br /> pergolas, andscaping,etc. �, r.. g ' <br /> • <br /> Property Owner's Name: Cj� 14bil 0 00 i' '(?YCI Y JV')SYlf' �-r->",3�'t.)` o o ein-- <br /> �� 1 alit-e- f ( 00.171_ <br /> Property Owner's Mailing Address: , I,b Li Y' { l b 4 si <br /> '� I'1 ��►�"i�'�s� b/'t�j i C' ! r $�tate Zi f,_ a' , <br /> Property Site Address: ?)--t 1,/.p! StLi Lc i .�? R' j <br /> � �J -7 y <br /> Contact's Telephone Number: (Id) 101 )P /(rfy� 1 (Thft n�"*s-:- /1�' 2,3�iy�) a �y <br /> it ,_ • i.� Zyj <br /> Contact's Email: �. 1\.V 1.)I/A I'�4.,)I-I6- L :(;,11/)4(.--1;'131,;.-1---r )`U�� o d <br /> Legal Description of Property: 2,:,)-- �" GS•),,, V/1 7 2Z$' �y�, `•.1' ? A-1.9 o \ , <br /> 4_ I� -, _ <br /> Section#:/�;•,i Town#: (./ N Range#: JW Town of: I ) fl}61 <br /> *Attach addition al page if neededfor lengthy description OR a"tta�ch a copy of the deed OR attach tax system property page.* E. <br /> Tax ID#(1-5 digit number;found on tax- tatement): 0607 Proposed Use of Structure/Addition: ( .4, ,)/).1 / 0 a <br /> Anticipated Start Date: /I— – ate;;,)/ (Home Cabin;Commercial Business;Bedroom;Deck;etc.) t a ij <br /> 1 ' �! ' r'1 '1 is i, 1 4 •---- <br /> Building Contractor: li 1�1 e, Alf}/). .40,‘.(% l G}�. Sewer Installer:!/�(j!�r �,;' `uA ✓''' "/ (1 ' <br /> 0 L <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TOL CONDITIONS LISTED BELOW: <br /> •fl1ee lI max- S z ' .= <br /> ; 0.Pie--11‘. <br /> nq 1104" - z e ce� 3 bec/rao s S5/4A/-?1.66- <br /> rer <br /> Fee Rec:3ouU <br /> y Check#: f'j(` tt <br /> Date of staff site visit: I 1 13h7/' Initials of to vis't staF igiie -f �/ ' rn <br /> 0 <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: /�/�-I w <br /> cn <br /> OFFICIAL: / DATE: <br /> UPON APPROVAL: APPLIC • /4'MUST POST COPY OF m a 1r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT llz <br /> r m n <br /> Transcendent: Page 1 of 4 (r 0 o r i u +u <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 al ,� ' c4 <br /> m m <br /> C <br /> a <br /> 3 L) <br />