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,, I Crop ` <br /> • LAND USE PERMIT APPLICATION— Burnett County, WI a id <br /> Applicant Complete All Sections Below This Line • <br /> a a o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) wG ``/��\ <br /> 1/ Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 FD '�1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 NO £O <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 /> c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C. ^ , <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 !v <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. \t\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t- g� <br /> 0 <br /> Property Owner's Name: 4i ) i i( i4 / 5A VV d4A 1.--€c.% IOC.117 ^rl ; <br /> Property Owner's Mailing Address: 260 S 5 W 1 1•,41`;e cAp-E WO) /- II <br /> 1- 3- . b O <br /> ity Ste i <br /> Property Site Address:2 9 241 �-T 1 Q� 4 t�✓+v‘,bv e_y WT. Sias 0 E <br /> ptaitiDv ey Z o N ca <br /> Contact's Telephone Number: i♦i Z Z— 371--9.301) r:-NA t y�, 115- Z54 -A53 0. <br /> Contact's Email: b0 ti (_h IJe_e_. L= y 11 tom, Le)1'Vl 0 <br /> t <br /> Legal Description of Property: LOT 2- C S (Y1*2q Z QA.. P25 y ov Ler(5) b 3 Q5` Do <br /> E. <br /> Section#: Q 1 Town#: 40k) N Range#: V\ W Town of: S L0 I I <br /> d <br /> gi <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): t 7 6 e 3 v) <br /> Proposed Use of Structure/Addition: IQ.e.w �".iO LA L . w <br /> ' x <br /> Anticipated Start Date: 0 U 1 2020 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° O <br /> nt <br /> Building Contractor: t �►�'d2s-0►t ,. Co v1/4.. (- Sewer Installer: ti p� \‘As SA 91 t Jt1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> --� >��youtIoo✓' ?At l,i0/ h , 1us7 haw- aft VD,na/e. z <br /> liccf r y-Xv. ,,,04 i /- P0075 s /e-#40 <br /> ---), SQlu'iry periA►ir/- /5 mNry . 2 be rvnv �, °Ally <br /> �J J f . MIA c'i� J�f//u 2V-7iYf� z, Fee Rec:� 1SL <br /> Ci b�r'ODW45 4�t101a �n f!/1 i = Check#: 9 <br /> Date of staff site visit: /0//. �M� Initials of site visit staff: <br /> rr <br /> Z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: �`"r DATE: �� �28 F= ...„_� <br /> w cD <br /> TIE <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF it - <br /> 1; WW 3 <br /> 3 —I (5 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N v, Eriiii <br /> Transcendent: - c P. <br /> Page1of4 mm la�Z r' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 < 3 <br /> m OW <br /> C <br /> a <br /> 3 <br />