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LAND USE PERMIT APPLICATION—Burnett County, WI 01 0 <br /> c <br /> Applicant Complete All Sections Below This Line c o <br /> Permit Types and Fees:(Please,check appropriate boxes) w2 <br /> CD <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G7 r.r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° W <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C• rl <br /> o <br /> Filling/Grading $150 Boathouse $500 isb. <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 C/' <br /> AD <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. l <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. IT 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- <br /> o • � <br /> Property Owner's Name:-BR( <br /> z <br /> , ,ti C pi ,1Q,, / ,.j p <br /> �7 °o <br /> Property Owner's Mailing Address:75'0 y t c4 J 07 � �� "j✓5 2B - <br /> �r , City State `.Zip c) <br /> Property Site Address:�7R CP►k L.Af1C , �,,V,,(i y � �5/ � <br /> y o � <br /> Contact's Telephone Number: /� -c,q6 �,Q,Q,, ;, <br /> d <br /> Contact's Email: r�`r o <br /> �Dr't 01 d prfec 1-1- Co J'1l'1 ADCD <br /> Legal Description of Property:Gr; iT fiCirCS iao <br /> g. <br /> Section#:_ y Town#: / / N Range#: 14, W Town of: J j d <br /> s <br /> J ad <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement):�ps�� ac .60 �l v, <br /> Proposed Use of Structure/ dd' 'on: iv`1 o x <br /> Anticipated Start Date: //ZU�t) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ` d <br /> ' 9 }, /1 H pi �.1Building Contractor: ✓,.1 tCSfi7) :.'sj�s7`��'�C'`I ' 0}1 Sewer Installer: /AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYN <br /> THIS PERMIT ISV <br /> .SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �o\\b`'�' ?10 , ?\(3°..Nz <br /> A r <br /> s Fee Rec: <br /> L'" Check#: 9.V2g <br /> �� d <br /> Date of staff site visit: '� ��� Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAINN. --- ATE: -3— I-7—ac3O <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Xs- <br /> UPON 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> c <br /> Transcendent: - Page 1 of 4 =.- r. <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/20207.:sj <br />