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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 WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit 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 treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 5 fCVA. <br />Property Owner's Mailing Address: 11"(0 C c� P "'�" �y��0- ,(►<u �` '""� G'� rYO f 7 <br />City State Zip <br />Property Site Address:—V-91 ?J .1 F- Ido° -J r"f ic-:c- 1W I $-1<b 3 q <br />Contact's Telephone Number: '7(5 - <br />Contact's <br />7(SContact's Email: S r1g k 5 u v <br />Legal Description of Property: <br />Section #: � Town #: 3 N Range #: 5' W 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): 1 1 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 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 />W,A,, <br />,, f� J / O) D � W N <br />Date of staff site visit: 9 L / ` Initials ofsit isit staff- 'S' <br />1�\ <br />� <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DATE:�Vl— <br />S, <br />UPON APPROVAL: APPLICANT POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: <br />syY, Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />~n <br />°o <br />a <br />m <br />5 <br />0 <br />0 <br />5' <br />ro <br />d <br />N <br />n <br />t~ <br />b <br />�l <br />w <br />x <br />-, Fee Rec: #145 <br />x <br />Check #: 353x- <br />0 <br />m <br />a <br />