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C'' <br /> LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> y N <br /> Applicant Complete All Sections Below This Line oo <br /> c <br /> Cl. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk bunkhouse 50 °2e �', <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures 350 r, <br /> 0 <br /> Filling/Grading $150 Boathouse $500 .� <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 a, <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. D, <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. q 04.\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r 5' <br /> Property Owner's Name: Gi-c_93 �G.S k s\►'ch1 �, p <br /> Property Owner's Mailing Address: 11 a-i L\- +k 5- v N <br /> aidak Ai <br /> A :57.,? a <br /> rr`, <br /> City State Zip =' EProperty Site Address: i CO1� IV. <br /> �y : <br /> Contact's Telephone Number: 1::;,51—3 8 -?- ?at-J( n <br /> Si +�'� d <br /> Contact's Email: (0 eta S //(\ G�i c p :: <br /> Legal Description of Property: &i7L/ 6. 14/ V, 2i1 /� /C Z-- / <br /> Section#: 2,e Town#: .3 7 N Range#: /J W Town of: 1—r1.1—r1.,(yC, Let Ice. <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach7a copy of the deed OR attach tax system property page.* 5'. <br /> Tax ID#(1-5 digit number; found on tax statement): !/T -72-7 <br /> p VIII 2 � � <br /> Proposed Use of Structure/Addition: �j� G,(age i <br /> Anticipated Start Date: ,,I 1 C Ga O (Home/Cabin, Commercial Ausiness;Bedroom;Deck;etc.) i C) <br /> Building Contractor: 0v.) ;ne.r Sewer Installer: ;,tt(Y,�TT P\V1,ty,6 - ; <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 11 NJ <br /> Motke. Suee- -e.ef di// s t 'h 44.5 z N <br /> Ale.alT� A Cf ve, b t t IA 4h o u S c_, A? v,t.e n-•.-r h * recce,r/de- 2 <br /> i <br /> by Sits/2&2,6 <br /> Fee Rec: Wer�' <br /> Check#: 7g3 <br /> v <br /> m <br /> Date of staff site visit: Initials of site visit staff: � c� <br /> 7/O v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: � /2-e ` ,.. Ril <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF F• E z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ?' µ fu <br /> Transcendent: - Page 1 of 4 w ` No <br /> ;CD <br /> CD Ril <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2020 <br /> a <br /> K <br /> -o <br />