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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 $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 />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 jWl State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 113oathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 jPermit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact 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 trea as accessory structures,�s�u+ch as: pergolas, landscaping, etc. <br />Property Owner's Name: Q11 a. G �r'1 �' r I%,f( <br />Property Owner's Mailing Address: IOU V K` QhffdS N <br />LA, <br />it Sta Zip <br />Property Site Address: 5 &Vllf r L e r <br />oF <br />Contact's Telephone Number: O� p g� Q q O� /I (AU <br />rtoereContact's Email: KY'aem e- r @ m Ql,01o��C`QSG <br />Legal Description of Property: LQ CJ M <br />-V-7 F, � � <br />Section #: Town #: N Range #:� W Town of: K f2o <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systena property page. <br />Tax ID # (1-5 digit number; found on tax stateme t): <br />Proposed Use of Structure/Ad ition, � <br />Anticipated Start Date: (Home C in: Commercial Busir s: Bedroonr: Deck: etc) <br />I ( J <br />Building Contractor: It'�P(1 I ev- #n V- 0. 11 e-, SewerlInstaller: <br />(A- i 16.' <br />IELOW THIS LINE FOR LAND SERVICES STAFF COMMWTS/CONDITIONS ONI <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />A-1 <br />Date of staff site visit: A <E Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DAT <br />qX O <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 />a <br />0 <br />z <br />r <br />z <br />m <br />cn <br />a <br />b <br />W <br />J <br />N <br />r <br />� o <br />C � <br />z 0 a <br />Fee Rec <br />Check #: Wag <br />