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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line = c <br /> Permit Types and Fees:(Please,check appropriate boxes) w <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 /> k Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 OQ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 / <br /> Filling/Grading $150 Boathouse <br /> $500 roo <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r ly <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ,5 ,Sr <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- 9 <br /> 0 <br /> o <br /> Property Owner's Name: On ' iD TANiJ W t 6,11/4 6R z, <br /> Property Owner's Mailing Address: 8 III a. W ESI 0 o c r o(z 1,4K ,t ). S(rf&.---"/ <br /> City State Zip I cn„ <br /> Property Site Address: a 3 ( (, C 0 L p 3,S- . .. C <br /> Contact's Telephone Number: 7/S-3 4 q'S"7o l a -R* <br /> Contact's Email: l,.) E 6 t'1 E R o f/R trio t L. N 1=f <br /> Legal Description of Property: / 3� G 4 V L-07 a L o % 'i C S'- U o 1°4Q G � ,. <br /> Se ion#,Town#:__ _N Range#: /7 W Town of: DAM k LS cm <br /> * ttd6!additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> m.a <br /> Tax ID#(1-5 digit number;found on tax statement): a •),s— <br /> Proposed Use of Structure/Addition: SI' CAA./Z Qo A f T R/!c t 0 fj <br /> Anticipated Start Date: A SAP (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d <br /> 7ki- <br /> Building Contractor: /V/A Sewer Installer: /O//; y <br /> 4-� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY /� <br /> THIS PERMIT ISSUBJECT TO ALL CONDITIONS LISTED BELOW: PS" L-P <br /> 0 lf\jaA-- ,k--0 i hvtwtqr kiii9i,irec4)san z g <br /> (eek ail Se-- G(-s <br /> Fee Rec:l <br /> VI , Check#: 5o/( <br /> 5 � o <br /> Date of staff site visit: � Initials o ite visit sty ' � ,�� r <br /> fr— <br /> cl <br /> APPROVED BY LAND SERVICES OFFICIAL: , "",e' DATE: 56 f 7f 7 j�) <br /> UPON APPROVAL: APPLICANT US POST COPY OF r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c z C7 <br /> CD <br /> Guy <br /> Transcendent: - <br /> Page 1 of 4 wo o — o <br /> rU <br /> Laserfische: - Burnett County, WI Land Use Application–Rev 1/2019 0 3, , <br /> ffila <br /> b <br /> a <br />