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* LAND USE PERMIT APPLICATION - Burnett County, WI a R b <br /> Applicant Complete All Sections Below This Line <br /> F.C7 <br /> Permit Types and Fees:(Please,check appropriate boxes) pO <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ''V, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �`O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 >•j A <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 '' 76,—, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> m <br /> *NOTE:After-the-fact permits(permit aqui red 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 4 <br /> o z <br /> Property Owner's Name: Ro r N u r p , o <br /> Property Owner's Mailing Address: 315 k...0 - e- k.11.)4 Rd i - b 1 l' ) 5q30 <br /> {� City State Lip In <br /> Property Site Address:39)1 - e,� lC X. !Sd D1401-A.,"-k) 10) 5-9a3 0 E <br /> <_ i, 1 <br /> Contact's Telephone Number: 1 15 - acp " Di J� a n <br /> C7 <br /> Contact's Email: 1;iJd \ )u('0141 L.30-1a,A •Cc.rvl I <br /> i <br /> Legal Description of Property: 1-04 1 CSM V 22- P299(4139LI )�1> (6,o,, 104-3" a <br /> Section#: 12. Town#: Li ) N Range#: 15 W Town of: SW;5S <br /> ° <br /> P <br /> *Rauch additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> I i <br /> Tax ID#(1-5 digit number; found on tax statement): Z.13 Il-)I � <br /> 5,,,, 3c 20 wn e..tf' ,chrrxe+. o lir yl <br /> Proposed Use of Structure/Addition: VAAM cionA,nS DCX- 0() So,-,rh '3 dda CCc rc C?rC' 10 , `t. -.4 <br /> Anticipated Start Date: 5,/,,p t ZC 2.0 (Home/Cabin:Commercial Business:Bedroom:Deck:etc) -g 6 <br /> Building Contractor: y'ler Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> CV <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N1 <br /> Ce-e V I,-}- `O R F 1V-a.\ P1O P/&v dotec/ x <br /> 51t)- -): -Ce C <br /> DO <br /> Fee Rec: L) <br /> - <br /> Check#:al"1a <br /> my____ .5 <br /> Date of staff site visit: �ab lniti I of site visit staff: ' _ <br /> APPROVED BY LAND SERVICES OFFICIA ' : • <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF f - k <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1 <br /> Transcendent: - <br /> Page 1 of 4 i r2 -:.-,.....5„.1 <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 '. <br /> y <br /> - <br />