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LAND USE PERMIT APPLICATION - Burnett County, WI <br />Appli[cant-044ip' ,sits:lreki;liltt <br />Permit Types and Fees: (Please, check appropriate boxes) , <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/industrial Structure $200 <br />Accesso 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 />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fad permits (permit aquired after construction has begun) may cost up to three times the n {rmai fee. <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: pergolds, landscaping, etc. <br />'roperty Owner's Name:�Zf nQi, <br />z,,.; el S-�c; s% 71"7-£ 62 <br />"Cl <br />'roperty Owner's Mailing Address: 77,9 52c" vY+ 111.011 <br />City State Zip <br />'roperty Site Address: %1-513 -��o A n S%, ��� t J tate <br />'ontact's Telephone Number: 7// S= �'c� 25'— <br />,ontact's Email: sC q s' Y leX 0 1 T, 1I ler <br />,egal Description of Property: o 7—'7 r---5 /1" Vi�s`��/ r ��✓ �u % X <br />;ecdon #: C73 Town #: 37 N Range #:_/e� W Town of. <br />'Attach additional page if needed.for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />-ax ID # (1-5 digit number; found on tax statement): D I / Q <br />Imposed Use of Structure/A dition:% tyt E ��'� t` n `� 5 % . 9 U <br />\nticipated Start Dater uj� (Home/Cabin: Commercial Business; Bedroom: Deck: etc.) <br />3uilding Contractor: _ ,/ Sewer Installer: <br />e�;<t� <br />C <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONrS LISTED BELOW:e <br />Q� 4z> a0 -/o �N`�erY�a'� Svt�i-ceS- <br />o�o a -�h{- �rl',�5� 37 , 5' �� S�ot^�1;��. � 1 �.��,,,rro-t�� <br />-q <br />o- \ D <br />late of staff site visit: I C — 3 O — 1 K Initials of site visit staff: <e Q3 <br />'ERMIT APPROVED BY LAND SERVICES OFF3Ci�// DATE: <br />60 <br />OL -1 <br />900"A U16,'!E. <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />� b <br />to H <br />s' <br />rP <br />o <br />o of <br />I� <br />_n <br />75 <br />-o <br />z r^ <br />0 <br />0 <br />iv C) <br />G U) <br />o N <br />G <br />a <br />U <br />0 00 <br />a <br />5' <br />CIO <br />0 <br />C4 <br />o � <br />� G <br />z <br />z <br />Fee Rec: 350 <br />neck #: 555 1 <br />