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LAND USE PERMIT APPLICATION — Burnett County, WI a 2ro <br /> Applicant Complete All Sections Below This Line o' <br /> a. i <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "7\,Z <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 E <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 A' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c. <br /> f? Filling/Grading $150 Boathouse $500 "— <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 c <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. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g" 5.. <br /> Property Owner's Name: .P.,14/1,:. S cyiofj 7z_ P <br /> Property Owner's Mailing Address: 76, 4' /D 1M Lc. PL ,M Al ss 1/7 b <br /> City State Zip g' r) T <br /> Property Site Address: 75—y 7 �j Cr iA; 4.k IC2) z ?co ,,t/ ' S'y 5.,-.5'o E <br /> C <br /> Contact's Telephone Number: tV .7-LI &i ic— 7/rJ 566 / 3 <br /> a <br /> / v <br /> Contact's Email: J Pi c cc <br /> /T 61 @ C>M9'/L , c— N <br /> Legal Description of Property: <O'T .3 • <br /> Section#: 33 Town#: '9/ N Range#: /4, W Town of: 5 W/SS <br /> G <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 4 <br /> 5' <br /> Tax ID#(1-5 digit number;found on tax statement): (9c.. 9 <br /> Proposed Use of Structure/Addition:'31//1) Cj 1 J h C ° x <br /> Anticipated Start Date: ' J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° Ei <br /> Building Contractor: ‘2)/3--/l) PR OM i Sewer Installer: AI t3 H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c-, Z? <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> TIN <br /> e Ahrr rti-f PIUMAA/ 1441- 111-71131 p; '-`0 <br /> -i Fee Rec: ra'Ob <br /> . litiliP <br /> m .1 ���-------------��� <br /> 5' <br /> Date of staff site visi ' Initials of site vis' taff: Ifil )/----- n ^7 <br /> 1 a. <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL DATE: �`CI ! hl <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t.3 <br /> col ..... \Tin- 1— <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 4 ; 1M <br /> Burnett County, WI Land Use Application—Rev 3/2018 � -) <br /> a <br /> b <br />