Laserfiche WebLink
LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />� <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading $150 Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) <br />$100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />X Q� <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:&IP an r 21�-� <br />4he 7C�eCe n y <br />Property Owner's Mailing Address: 2 gg �a t45'g t/r <br />N <br />/ <br />Property Site Address: 3 ���f y z4/� ���65 S 5�i City State Zip <br />Contact's Telephone Number: 0-/ 233 YYKO rr C-5- 0107 <br />Contact's Email: A C (eG Yu�Ca�,�,c Q S fi. !?e <br />Legal Description of Property: <br />Section #: Town #: V_X Range #: I& Town of: Su.) I ss <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): , 2 !/ � q4 9, a i!{% <br />Proposed Use of Structure/Additiot}: 5+V`tC1c�, j3�� tre S <br />Anticipated Start Date: ( (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: d S C— Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITI N LISTED BELOW: <br />— G slq 1'?'s7/- le - <br />Co � CIA e__ A Q ✓ cC e/f - <br />Date of staff site visit: Initials of ite visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 3/2018 <br />V) <br />w <br />CDr, <br />-o <br />� <br />r � <br />0 <br />z <br />o <br />^n <br />0 <br />0 <br />o. <br />ii <br />0 <br />rD <br />00 <br />r <br />0ro <br />C. <br />n <br />W <br />X Q� <br />N <br />z <br />z Fee Rec: <br />r.���ZSvg,T <br />0 <br />m <br />