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LAND USE PERMIT APPLICATION-Burnett County, WI a r <br /> s" b <br /> Applicant Complete All Sections Below This Line o o <br /> a _ <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I,' <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 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> f Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 N <br /> 7. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r. d i_. <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 E <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. - ID <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> Property Owner's Name:L'i✓)21 .. �. .&_ b U kI 41 <br /> Property Owner's Mailing Address: 99 '/I ` ' I,i 1-f S 7 d -5 j 12E/U / 5Y ?z b <br /> City State Zip e. �; <br /> Property Site Address: 95-qt })I ' �U l / -3 1 6 E <br /> Contact's Telephone Number: / t/J " 2"Z-Z,— /La co, <br /> Contact's Email: til RI i.5..-A N1) 1Z,50NI )1.b e Tri-1 h v, (,b M <br /> 2. <br /> Legal Description of Property: 5t" C. Z I 7V 'c� < G (-7 Pa_ ( o V j---6T7 .0 <br /> o <br /> Section#: J Town#: 3cir N Range#: 17 W Town of: I)(-II&; L5 9. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 5. <br /> Tax ID#(1-5 digit number;found on tax statement): L. 3( <br /> Proposed Use of Stricture/Addition:fl CCE f")5 TO L A,r E E <br /> Anticipated Start Date:-1-.6 D (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) G <br /> Building Contractor:1--0 OU 4--C H 1 13 I+(-J) Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> as- 15-' <br /> s Or\sk ,e, 5v re SiepS -I- -"e Pay.Lv beA3 1 r\ z <br /> l ---e_e,-t- -.co m S ho‘t..`c r- C5T ie..' 0115aLdt <br /> I^ <br /> H Fee Rec: (,*4----) <br /> g g....4:X <br /> y Check#: 1(xj`j <br /> Date of staff site visit: ' Ini is of site visit staff: <br /> YAPPROVED BY LAND SERVICES OFFICIA DATE: Suri X 0 Q ' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a a rD. <br /> �inl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 ?3 N <br /> Transcendent: - p o ccs <br /> Page 1 of 4 „ a ry <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/2020 <br /> x:, <br /> n <br /> Nil <br /> H - <br /> I <br />