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CA -0 tni <br /> LAND USE PERMIT APPLICATION - Burnett County, WI 0 <br /> Applicant Complete All Sections Below This Line 5' c o <br /> 0. <br /> P rmit Types and Fees:(Please,check appropriate .._ <br /> yp boxes)+ <br /> Dwelling/Principal Structure $300 % ion/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $2000 <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 /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i • <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 r -k— <br /> c. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> 1 <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. r <br /> 0 <br /> z r <br /> Property Owner's Name: S Co'f-fi Lo....(ler- <br /> m % <br /> o <br /> Property Owner's Mailing Address: eQ_ 6, 3c./ T a. <br /> s <br /> City State Zip <br /> Property Site Address: Z 4/33 1 �rG„ber7 Agri* ktz 1'ydr71 <br /> / ebsh� o <br /> Contact's Telephone Number: ,—g` - 1z4 - `7�f`� :. • a <br /> o <br /> Contact's Email: ---- <br /> I <br /> Legal Description of Property: LM I. GSM V 17 P L3 9 # HS'`t (PLL N ao <br /> Section#: Q q Town#: g N Range#: 15— W Town of: 441 41j lit, I <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): ,?j 5:5 Z- cn <br /> Proposed Use of Structure/Addition: ,v o x <br /> Anticipated Start Date: y-2?-20 (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) p <br /> Building Contractor: ((:' /4Aie m— Sewer Installer: Py/l2 —i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ILL CONDITIONS LISTED BELOW: o <br /> • EX t S}4h dwelliill be 05nve -*ez4 u3ol K 5)-top 'nKN C' z <br /> ooh of Meed ' o-th.er zon;nwe <br /> C reftAfre � Y.-ks& S/,/d�� <br /> 1 <br /> ' Mita\--a%A Sq IN t-'°`f I of. h'N --\-`o Etkr\K1'‘ekkS2. <br /> ll <br /> • Ct , < • ?Cope c\.1 S i 2_e__ l-ko a 5 C PO t' "S*1-0 irk,(dQ. &u nn lc ate ' <br /> �,;-6 KV- � s Fee Rec: )__— <br /> Check#: 3 <br /> o <br /> rri <br /> Date of staff site visit: d� �� Initials of site visit staff: <br /> z <br /> KAPPROVED BY LAND SERVICES OFFICIAL: DATE: ` CROaf� <br /> 0. <br /> UPON APPROVAL: APPLICANT MUST POST C PY OF y a p. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o g a N rIj <br /> wo ..... <br /> u. <br /> Transcendent: - Page 1 of 4 m e °� o <br /> IV C4 <br /> Laserfische: Burnett County, WI Land Use Application-Rev 1/2020 r, a."Z <br /> MI Ci = Ng <br /> L..J <br />