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• <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a r <br /> Po <br /> Applicant Complete All Sections Below This Line s <br /> a * N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> x Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 .9.- <br /> Six <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn <br /> p <br /> ,.. r <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. CA <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r, <br /> 0 <br /> Property Owner's Name: ?y: v\ 1 Z A S Te !ZIA- <br /> Q 3- <br /> Property Owner's Mailing Address: 8 331 S SST N Si LOCI 4,,E 6 R.ouE OW 5SOV b -8- <br /> E". <br /> ,v <br /> City tg n <br /> Property Site Address: Z 841 30Nr&5oit� LK R)) wC..Si ert Wt State <br /> 5 Zip < -0 <br /> Contact's Telephone Number:IZQM) l k S "5 (01-.›.--Z435- <br /> Contact's Email: 'b rCk CX 0 e vemoMV { Ublc • Lb h/1 , <br /> Legal Description of Property: LO 1 Z L S m V 7 P k l 9 °) Lo T `& N &)" <br /> Section#: IA Town#: 40 N Range#: IA:, W Town of: d ANC LIA'.-, w' w <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* '-Q <br /> Tax ID#(1-5 digit number;found on tax statement): V <br /> ' 303 <br /> N <br /> Proposed Use of Structure/Addition: r.S Q .0 tYM 1 c_o._vv "� o x <br /> Anticipated Start Date: J'ep j (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 7t, - ° p <br /> Building Contractor: P' ve_wi SOh Co 5 1 Sewer Installer: 007kt4VL I -i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY '� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q S W <br /> 2 ,4j07L <br /> 742 3 h e t /Ie.,^ 6.7011 Apy /eM/7& <br /> zk. W <br /> SnN--ZZ--/5t <br /> do o6.-,,, .N p p woe__ p •- <br /> /vee sq..,/'s h, -Hit_ l4 Fes- Ge.K L T"�N G' '/� •0 id S 714 ii, <br /> 4v b cco IMP Vl dy Kiwi O vtaiG1N d ve,V ji e..74tFee Rec: <br /> 7 Check#:1D b l 5 <br /> 0 <br /> Date of staff site visit: g/Z,3/ZQZZ.Initials of site visit staff: itT i <br /> ['"—� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9/ AT Fril <br /> UPON APPROVAL: APPLICANT MUST POST !!COPY OFtn co = 40 ? <br /> mil <br /> � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - o <br /> �� <br /> N Q <br /> Transcendent: Page 1 of 4 •' ^' <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 3 _ Nil' 1 <br />