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ff <br />LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure N$1000 <br />Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 <br />Driveways/ & Campground Structures WI State Statute 59.692(1v) Structures $350 <br />Fillin Grading Boathouse $500 <br />Six Month Camping Unit (One Per Year) 1 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fad permits (permit aquired after construction has begun) may cost up to three times the normal fee. <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: R[ �!, <br />YT A q ,;" 1 <br />Property Owner's Mailing Address: 7.7 R an U' sZ7 <br />City State Zip <br />Property Site Address: SO ►'�--_ <br />Contact's Telephone Number: Z <br />Contact's Emai'/ - 4 �/ — 0— a' /> r • �)✓� <br />Legal Description of Property: !� <br />Section #: !;— Town #:_ N Range #: W' <br />Town of <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): 129a / <br />Proposed Use of Structure/Ad ition: CGVf oY r,e x 0,4�7 <br />Anticipated Start Date: / f (Home/Cabin,, Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: <-k-1 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 />91St^►�� <br />-a� <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: �D <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />n <br />C <br />0 <br />K01 <br />o� <br />� Fee Rec: /527, <br />Check #:14 — <br />d <br />m <br />