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- LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> y N <br /> Applicant Complete All Sections Below This Line 3' w <br /> c e <br /> Permit Types and Fees:(Please,check appropriate boxes) ,"' �°" 1........). <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 R <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .[— <br /> V. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,amu <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> G7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °< <br /> Filling/Grading $150 Boathouse $500 o Q <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 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. <br /> Property Owner's Name: .17)4 r) hi` C�k i f-/€Ps ENo r <br /> g �44u / /1'A/ SY/O4 o i <br /> Property Owner's Mailing Address: f 757CRN 4(1E4(1E" o <br /> n.4 <br /> / / City State Zip <br /> Property Site Address: a c 4 (1 en-I t N c �t( �u6 'o. rip 10 <br /> Contact's Telephone Number: 4I2 ` 1417— 3 9 7c2 o N <br /> CD <br /> Contact's Email: O R'CA/1.i 5 7 eil.rEN & e-D/1?G 4S k ,A/E71 <br /> o <br /> ro <br /> Legal Description of Property: 01-6.24-1-37-pi-/o -f sOS-U O%-O/G 6 00 .. <br /> / o 00 <br /> Section#: f 0 Town#: 3(1 N Range#: / / /�`T W Town of: eAs'k 0 <br /> 5. <br /> as <br /> *Attach additional page if needed for lengthydescription OR attach a copy othe deed OR attach tax system roperty pae.* <br /> d <br /> Tax ID#(1-5 digit number; found on tax statement): / cl//S'7cq <br /> P <br /> Proposed Use of Structur /Addition: POft,R 14F J /1 E v, <br /> H <br /> Anticipated Start Date: Jib./ t ab?a (Home/Cabin;Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> DIV 0 <br /> BuildingContractor: 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 /> trli,init n,,crd,,to contact their I IN ln.speet..r to determine r/a permit i,heeded from them prior to <br /> ,traction taking place for any dwellings, &veiling additions, ttlaltufaeltired homes, mannfllctured Z <br /> . ,..'l Ytise4.''. . v <br /> li Sited Pt* -b be abed 4r kw L' h <br /> Fee Rec: L/? <br /> c o Check#: <br /> / <br /> Date of staff site visit: 0,3/3021 Initials of site visit staff: z l <br /> APPROVED BY LAND SERVICES OFFICIAL ,f/ DATE: I6/25A0,?.0 [(ll <br /> UPON APPROVAL: APPLICA UST POST COPY OF . C <br /> CO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �, <br /> `.G tNJ <br /> Transcendent: - Page 1 of 4 <br /> gi <br /> Laserfische: Burnett County, WI Land Use Application —Rev 6/2020 0 <br /> r <br />