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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line _ <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i P <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> l77 <br /> Driveways/&Campground Structures $125 WI State Statute 50.6.22(1v)Structures $3S0 o) <br /> Filling/Grading 5150 Boathouse $500 N I <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 ee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> �.1oc�1W e p ( �... �`.z- s s • <br /> Property Owner's Name: m {�; e�eS l DgA ,n, ,-Q,;r,el, o <br /> Property Owner's Mailing Address: Po ey,x Lala oc,,„Qi U u) ft 3O g e <br /> City _Suite Zip v <br /> Property Site Address: a�a�1 0.v�tni'yfAOa) . i c 54 30 a• n <br /> C SI <br /> Contact's Telephone Number: (� <br /> t '" - Q�3 _______ 4 3(D o <br /> tQ �r R <br /> Contact's Email: e-� �U caeS.C�+m p <br /> My1'J 'L i tckLegal Description of Property: Lo} ` M a 30A tJt`14 0 cAle„,,I'�a- E'14 oe,44 ' <br /> T R. ro <br /> Section#: p11 Town#: y© N Range#: `') R' Town of: .JG,C�a('� a 00 <br /> *Attach additional page i f needed for lengthy description OR attach a copy of the deed OR attach tax system property page.' t <br /> Tax ID A(1-5 digit number;found on tax statement): 54 ? 3. <br /> Proposed Use of Structure/Addition: rr7 n <br /> Anticipated Start Date:_7— ! — 2.0 2 Z _ rHome`Cabin:Commercial Business•:Bedmnnt:Deck etc.) o wt <br /> Buildin Contractor: E3 <br /> Building Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDIT1ONS ONLY ,o..\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ``Tlir a ppili urtt nrcc,ls 10("reatttr1111dt•I l)(Ju.;:er t111*ru defer-mm :'if a permit h needed/runt!hent pros to <br /> -11 i'tun!tructir,n taking place"ar ani dive/Mut,. divellin4,additions,imam faetured lruure., nrunuiurrured z <br /> Co <br /> home rlalrlir;nm, rtir;l hanthotl.,es.: x <br /> yMee-A-- 0,11 5e j-b <br /> 5 /10Fcli hrt k h`J;43 <br /> O>9 <br /> Fee Rec:1 rj <br /> 6 Check#: 4 - 3 I <br /> 6/ /? ) <br /> Date of staff site visit: X03 mill Is of ' e visit -,, a / _ <br /> ' `� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 603/0)-,1 <e IJ <br /> UPON APPROVAL: APPLICAN UST POST COPY OF K N4 o <br /> 4I nr,n • U� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGH 0 U N ii t <br /> Transcendent: - Page 1 of 4 g , <br /> Laserfische: Burnett County,WI Land Use Application—Rev 12/2020 1 c <br /> i <br />