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LAND USE PERMIT APPLICATION - Burnett County, WI S <br /> T 56 <br /> Applicant Complete All Sections Below This Line r. <br /> p <br /> ;,:-• = 11 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> XDwellin <br /> g/Princi al p Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i ��-s <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i± <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $1501"„/' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 J <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 _ 1. <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ,, <br /> a <br /> 'NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ! a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> r. <br /> `Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g r <br /> Property Owner's Name: D(L i�t t-'.,1 1 ) ����,=_. 4► SS' �\E/ _ '.4... <br /> �� _ i^ <br /> Property Owner's Mailing Address: -7l Loci Ci-c,1-..c. (:Cir1� „i:;.> 1 u( cz,L. --cc( 1_3 4 <br /> City �i State Zip <br /> Property Site Address: L3 5 _ �,L)LLAA-L1 (�Ur~c .. 4 < /� w-r' l z ':1 3-(-/S ni - <br /> / r <br /> J 14/` <br /> Contact's Telephone Number: ?L- -'5S�k� (3 G r 7 iJ`S.y; 2.)� ' �IJ <br /> Contact's Email: LA-)IA iSch•f r /-,Q4i?1Q_cI . tert� <br /> Legal Description of Property:4I' ) (k...01 ,rA V .: (�{�-,_ -ems 1 n 6.-:Cil I o't 2_ I 7 <br /> I <br /> Section#: _,�(o Town#: Li G N Range#: ,/ 41 W Town of: 5 fit,,•{--f ,. <br /> *Attach additional page if needed for lengths description OR attach a copy(Ole deed OR attach tax system property page * <br /> 0Tax ID-(1-5 digit number:found on tax statement): /(y 'S- 7 7 ,f1 <br /> I <br /> Proposed Use of Structure/Adds ion: C/( <br /> Anticipated Start Date: (r 57,-/7,73-./.e.... (Home Cabin. Commercial Business:Bedroom. Deck:etc) I:041cl ; = <br /> 7 _ <br /> Building Contractor: . `���C Sewer Installer: ? <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I •WKt <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> S of baR.k- b efiwe e.el llo tik- e °o ld Sketst c -rte.. z ' .. <br /> C be, a& lead�- 5- -1—_ <br /> • .. L n - ; cry �ia,,rt b (�/��.f� �l <br /> is rt ' e 'r- ' t' a'�1aX ` R'e 4A rCT�- <br /> btO. v L&>ne_ ' 1 dao tkixin sa.ardert rilu rte, JC <br /> (A; <br /> y l l _ Fee Rec:� <br /> • /00) ` D et!1(1) per cevv6,(/451-101qA , ii4 \1. : Check k: L.,(2).-,-5)-2 <br /> Date of staff site visit: CJe12. iti etsite visit staff: <br /> y <br /> APPROVED BY LAND SERVICES OFFICIAL. r �/ �� x '""— '— <br /> co ll3 <br /> UPON APPROVAL: APPLICANT MUST POST OPY OF • gt z 02 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ;, 511 <br /> 0 r� <br /> CD c tti <br /> Transcendent: - Page � <br /> 1 of �? <br /> . a <br /> Laserfische: - Burnett County, WI Land Use Application- Rev 1/2019 <br /> b <br /> L JJ <br />